Chughtai Morad, Perfetti Dean C, Khlopas Anton, Sultan Assem A, Sodhi Nipun, Newman Jared M, Gwam Chukwuweike U, Maheshwari Aditya V, Mont Michael A
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
Surg Technol Int. 2017 Dec 22;31:177-181.
Atrial septal defect (ASD) is a common asymptomatic congenital heart condition that predisposes patients to paradoxical emboli in the cerebral vasculature. In this study, we evaluated the prevalence of ASD and risk of stroke for patients with ASD undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
We used the New York Statewide Planning and Research Cooperative System to identify 258,911 elective primary THA/TKA between 2005 and 2014, including 140 patients with ASD. Logistic regression models calculated odds ratios (OR) and 95% confidence intervals (CI) and controlled for demographic and medical risk factors for stroke.
The prevalence of ASD was 54 per 100,000 patients undergoing THA/TKA. The rate of stroke within 30 days of surgery was 5.7% (95% CI: 2.5%, 11.0%) for patients with ASD, and 0.1% (95% CI: 0.1%, 0.1%) for all other patients. In regression models, the risk of stroke was 70 times greater (OR: 70.0, 95% CI: 32.9, 148.9) for patients with ASD compared to patients without this condition (p<0.001).
Patients with ASD undergoing THA and TKA are predisposed to stroke in the postoperative period. Orthopaedic surgeons indicating patients for surgery and internists performing preoperative medical clearance should be aware of these risks and discuss them prior to surgery. The efficacy of pharmacological and surgical measures to reduce postoperative stroke within this patient population should be topics of future investigation.
房间隔缺损（ASD）是一种常见的无症状先天性心脏病，会使患者易发生脑血管系统的反常栓塞。在本研究中，我们评估了接受初次全髋关节置换术（THA）和全膝关节置换术（TKA）的ASD患者中ASD的患病率及卒中风险。
我们使用纽约州全州规划与研究合作系统，在2005年至2014年间识别出258,911例择期初次THA/TKA患者，其中包括140例ASD患者。逻辑回归模型计算比值比（OR）和95%置信区间（CI），并对卒中的人口统计学和医学风险因素进行了控制。
接受THA/TKA的患者中ASD的患病率为每10万人中有54例。ASD患者术后30天内的卒中发生率为5.7%（95%CI：2.5%，11.0%），其他所有患者为0.1%（95%CI：0.1%，0.1%）。在回归模型中，与无此疾病的患者相比，ASD患者的卒中风险高70倍（OR：70.0，95%CI：32.9，148.9）（p<0.001）。
接受THA和TKA的ASD患者在术后易发生卒中。为患者安排手术的骨科医生和进行术前医学评估的内科医生应了解这些风险，并在手术前进行讨论。降低该患者群体术后卒中的药物和手术措施的疗效应作为未来研究的课题。
