Smeets Mark J R, Gademan Maaike G J, Nelissen Rob G H H, Cannegieter Suzanne C, Nemeth Banne
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
Department of Orthopaedics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
Arthroplast Today. 2025 Jan 3;31:101597. doi: 10.1016/j.artd.2024.101597. eCollection 2025 Feb.
Age and sex are well-known risk factors for cardiovascular complications and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Yet, stratified up-to-date absolute risk estimates, which are needed to optimize prevention, are lacking.
All Dutch patients who had a first primary THA and TKA for osteoarthritis between 2015 and 2021 were included. Data on baseline characteristics, procedures, and outcomes were obtained from the Dutch Hospital Data and Population registries, after linkage. Overall risks for venous thromboembolism, arterial thromboembolism, bleeding, and all-cause mortality were estimated at 30 and 90 days following surgery. Time trends were assessed by plotting 90-day risks by year. Lastly, 90-day risks were stratified by age and sex categories.
A total of 123,809 THA and 132,726 TKA patients were included. Females accounted for 63% and 65% of THA and TKA patients, respectively. At 90 days, overall risks were all below 1%. We observed no clear time trends in the risks over recent years. The stratified analysis showed that especially men older than 80 have a complication risk of at least 3%. Interestingly, the risk of venous thromboembolism and bleeding, following a THA, was observed to be relatively high in men and women in the youngest age category.
Generally, the 90-day incidence of cardiovascular complications and all-cause mortality is low but can be at least 3% for men in the highest age category. With this knowledge, perioperative preventive measures can be targeted more precisely, and shared decision-making improved.
年龄和性别是全髋关节置换术（THA）和全膝关节置换术（TKA）后心血管并发症及死亡率的已知风险因素。然而，缺乏用于优化预防措施所需的分层最新绝对风险估计值。
纳入2015年至2021年间因骨关节炎首次接受初次THA和TKA的所有荷兰患者。在进行数据链接后，从荷兰医院数据和人口登记处获取基线特征、手术过程和结果的数据。估计术后30天和90天时静脉血栓栓塞、动脉血栓栓塞、出血和全因死亡率的总体风险。通过按年份绘制90天风险来评估时间趋势。最后，按年龄和性别类别对90天风险进行分层。
共纳入123,809例THA患者和132,726例TKA患者。女性分别占THA和TKA患者的63%和65%。在90天时，总体风险均低于1%。我们未观察到近年来风险有明显的时间趋势。分层分析表明，尤其是80岁以上的男性并发症风险至少为3%。有趣的是，在最年轻年龄组的男性和女性中，THA后静脉血栓栓塞和出血的风险相对较高。
一般来说，心血管并发症和全因死亡率的90天发生率较低，但最高年龄组的男性发生率可能至少为3%。有了这些信息，围手术期预防措施可以更精准地靶向实施，共同决策也能得到改善。
