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Predictors of ischemic stroke after hip operation: a population-based study
Alina S Popa1, Alejandro A Rabinstein, Paul M Huddleston
1Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Hip surgery patients face a 3.9% risk of ischemic stroke within a year. Hip fracture repair and prior stroke history are key predictors of this serious complication.
Area of Science:
- Geriatric Surgery
- Neurology
- Epidemiology
Background:
- Hip operations are common in older adults (65+).
- These procedures include total hip arthroplasty (THA) and hip fracture repair.
- Understanding postoperative complications is crucial for patient care.
Purpose of the Study:
- Identify predictors of ischemic stroke after hip surgery.
- Quantify the risk of stroke in this patient population.
Main Methods:
- Population-based historical cohort study.
- Included residents of Olmsted County undergoing hip surgery (1988-2002).
- Ischemic strokes identified via medical records, diagnostic codes, brain imaging, and physician review.
Main Results:
- 3.9% cumulative incidence of ischemic stroke within 1 year post-operation.
- Significant predictors included hip fracture repair (HR, 3.80), history of stroke (HR, 4.18), and age 75+.
- Multivariable analysis confirmed history of stroke (HR, 3.27) and hip fracture repair (HR, 2.74) as strong predictors.
Conclusions:
- Hip operations carry a notable risk of ischemic stroke.
- Hip fracture repair and a prior stroke history are the most significant risk factors.
- These findings aid in risk stratification and patient management.
Background:
Hip operation (total hip arthroplasty [THA] or fracture repair) is the most common noncardiac surgical procedure performed in patients age 65 years and older.
Objective:
To determine the predictors of ischemic stroke in patients who have undergone hip operation.
Design:
Population-based historical cohort study, in which postoperative ischemic strokes were identified from medical record review for stroke diagnostic codes and brain imaging results and were confirmed by physician review.
Setting:
Tertiary care center in Olmsted County, Minnesota.
Patients:
Residents of Olmsted County who underwent hip surgical procedure.
Measurements:
Incidence of ischemic stroke within 1 year of hip operation.
Results:
In total, 1606 patients underwent 1886 hip procedures from 1988 through 2002 and were observed for ischemic stroke for 1 year after their procedure. Sixty-seven ischemic strokes were identified. The rate of stroke at 1 year after hip operation was 3.9%. In univariate analysis, history of atrial fibrillation (hazard ratio [HR], 2.16; P = 0.005), hip fracture repair vs. total hip arthroplasty (HR, 3.80; P < 0.001), age 75 years or older (HR, 2.20; P = 0.02), aspirin use (HR, 1.8; P = 0.01), and history of previous stroke (HR, 4.18; P < 0.001) were significantly associated with increased risk of stroke. In multivariable analysis, history of stroke (HR, 3.27; P < 0.001) and hip fracture repair (HR, 2.74; P = 0.004) were strong predictors of postoperative stroke.
Conclusions:
This population-based historical cohort of patients with hip operation had a 3.9% cumulative probability of ischemic stroke over the first postoperative year. Hip fracture repair and history of stroke were the strongest predictors of this complication.
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