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Thrombotic and bleeding complications after orthopedic surgery
Brandon S Oberweis1, Swetha Nukala, Andrew Rosenberg
1Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
American Heart Journal
|March 5, 2013
Summary
Orthopedic surgery patients face risks of blood clots and bleeding. Age, heart disease, cancer, and kidney disease increase clot risk, while procedure type and other factors impact bleeding risk.
Area of Science:
- Orthopedic Surgery
- Cardiovascular Complications
- Hemorrhagic Complications
Background:
- Thrombotic and bleeding complications are significant concerns in orthopedic surgery.
- Limited data exists on the incidence and risk factors for these events.
Purpose of the Study:
- To investigate the incidence and risk factors for thrombotic (myocardial necrosis and infarction) and bleeding events in orthopedic surgery patients.
Main Methods:
- Retrospective cohort analysis of 3,082 patients undergoing hip, knee, or spine surgery.
- Data collected via ICD-9 coding, medical record review, and laboratory/blood bank databases.
- In-hospital outcomes included myocardial necrosis, major bleeding, myocardial infarction, and hemorrhage.
Main Results:
- Myocardial necrosis occurred in 5.8%, myocardial infarction in 0.7%, major bleeding in 5.4%, and hemorrhage in 0.8% of patients.
- Independent predictors of myocardial necrosis: increasing age, coronary artery disease, cancer, chronic kidney disease.
- Independent predictors of major bleeding: procedure type, cancer, female sex, coronary artery disease, chronic obstructive pulmonary disease.
Conclusions:
- A delicate balance exists between thrombotic and bleeding events in the perioperative period after orthopedic surgery.
- Perioperative risk assessment for both thrombosis and bleeding is crucial.
- Future prospective studies are warranted to mitigate these risks.
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