Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty: A Clinical Registry Study of 24,862 Procedures

TY - JOUR

T1 - Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty

T2 - A Clinical Registry Study of 24,862 Procedures

AU - Petersen, Pelle B

AU - Kehlet, Henrik

AU - Jørgensen, Christoffer C

AU - Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group

N1 - Copyright © 2018 Elsevier Inc. All rights reserved.

PY - 2019/4

Y1 - 2019/4

N2 - BACKGROUND: Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4%-0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA.METHODS: We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population.RESULTS: Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11%; 95% confidence interval [CI], 0.08%-0.16%) and 43 strokes (0.17%, 95% CI, 0.13%-0.23%) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95% CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95% CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95% CI, 0.98-4.6, P = .055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population.CONCLUSION: Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.

AB - BACKGROUND: Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4%-0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA.METHODS: We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population.RESULTS: Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11%; 95% confidence interval [CI], 0.08%-0.16%) and 43 strokes (0.17%, 95% CI, 0.13%-0.23%) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95% CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95% CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95% CI, 0.98-4.6, P = .055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population.CONCLUSION: Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.

KW - Aged

KW - Aged, 80 and over

KW - Anemia/complications

KW - Anticoagulants/adverse effects

KW - Arthroplasty, Replacement, Hip/adverse effects

KW - Arthroplasty, Replacement, Knee/adverse effects

KW - Cohort Studies

KW - Comorbidity

KW - Denmark/epidemiology

KW - Elective Surgical Procedures

KW - Female

KW - Humans

KW - Incidence

KW - Length of Stay

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Registries

KW - Risk Factors

KW - Stroke/epidemiology

U2 - 10.1016/j.arth.2018.12.022

DO - 10.1016/j.arth.2018.12.022

M3 - Journal article

C2 - 30665835

SN - 0883-5403

VL - 34

SP - 743-749.e2

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

IS - 4

ER -