Chokshi Shivan N, Liu Vanessa, Weiss William M
John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas.
Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas.
J Arthroplasty. 2024 Mar;39(3):825-830. doi: 10.1016/j.arth.2023.09.019. Epub 2023 Sep 25.
This study investigated the prevalence of adverse cardiac events following a total joint arthroplasty and subsequently analyzed risk factors that may increase the likelihood of these events.
Data for this study were extracted from a large national database. Chi-squared analyses and multivariate modelings were performed to determine the risk factors associated with 30-day perioperative troponin elevation, myocardial infarction (MI), and heart failure. We identified 80,544 total hip arthroplasty (THA) patients and 112,531 total knee arthroplasty (TKA) patients and analyzed the following cardiac risk factors: diabetes, renal insufficiency, prior MI, hypertension, and cerebrovascular disease.
There were 34% of THA patients and 52% of TKA patients who had at least one of the studied risk factors. At-risk THA patients had 2.2, 5.9, and 5.3 times the odds of troponin elevation, MI, and postoperative heart failure, respectively, within 1 month compared to the control group (P < .0001). The TKA group had 2.9, 5.3, and 5.9 times the odds of troponin elevation, MI, and postoperative heart failure within 1 month compared to the control group (P < .0001). For both procedures, prior MI had the highest odds of resulting in perioperative troponin elevation and MI. Renal insufficiency had the highest odds of resulting in perioperative heart failure.
Risk stratification for postoperative complications in orthopedic surgery is important to minimize adverse outcomes. This study highlights the need for consideration of risk factors prior to joint arthroplasty surgery.
Level III, Prognostic.
本研究调查了全关节置换术后不良心脏事件的发生率，并随后分析了可能增加这些事件发生可能性的风险因素。
本研究的数据取自一个大型国家数据库。进行卡方分析和多变量建模，以确定与30天围手术期肌钙蛋白升高、心肌梗死（MI）和心力衰竭相关的风险因素。我们识别出80544例全髋关节置换术（THA）患者和112531例全膝关节置换术（TKA）患者，并分析了以下心脏风险因素：糖尿病、肾功能不全、既往心肌梗死、高血压和脑血管疾病。
34%的THA患者和52%的TKA患者至少有一项所研究的风险因素。与对照组相比，有风险的THA患者在1个月内肌钙蛋白升高、心肌梗死和术后心力衰竭的几率分别为对照组的2.2倍、5.9倍和5.3倍（P < .0001）。与对照组相比，TKA组在1个月内肌钙蛋白升高、心肌梗死和术后心力衰竭的几率分别为对照组的2.9倍、5.3倍和5.9倍（P < .0001）。对于这两种手术，既往心肌梗死导致围手术期肌钙蛋白升高和心肌梗死的几率最高。肾功能不全导致围手术期心力衰竭的几率最高。
骨科手术术后并发症的风险分层对于将不良后果降至最低很重要。本研究强调了在关节置换手术前考虑风险因素的必要性。
III级，预后性。
