Acute stroke after total joint arthroplasty: a population-based trend analysis.

Area of Science:

• Orthopedic Surgery
• Neurology
• Epidemiology

Background:

• Acute stroke is a serious complication following total joint arthroplasty (TJA).
• Understanding trends and predictors of stroke in TJA patients is crucial for improving patient outcomes.
• Nationally representative data can provide insights into the epidemiology of perioperative stroke.

Purpose of the Study:

• To determine the trends in acute stroke incidence among patients undergoing TJA.
• To identify independent predictors of perioperative stroke in the TJA population.
• To assess the impact of stroke on in-hospital mortality after TJA.

Main Methods:

• Retrospective analysis of the Nationwide Inpatient Sample database.
• Inclusion of 1,762,496 primary or revision total hip and total knee arthroplasties performed between 2002 and 2011.
• Logistic regression analysis to identify stroke predictors and mortality impact.

Main Results:

• The overall incidence of stroke after TJA was 0.14%, with a statistically significant decrease from 0.17% in 2002 to 0.14% in 2011.
• Stroke significantly increased in-hospital mortality (9% in stroke patients vs. 0.15% in general TJA patients), with stroke being a strong predictor of mortality (OR, 27.73).
• Independent predictors of stroke included pulmonary circulation disorders, advanced diabetes mellitus, cardiac arrhythmia, peripheral vascular disease, valvular heart disease, renal disease, and revision hip arthroplasty.

Conclusions:

• Despite a declining trend, stroke remains a major contributor to in-hospital mortality following TJA.
• Identifying patients at risk for stroke, based on factors like pre-existing comorbidities, is essential.
• Proactive management and resource allocation for high-risk TJA patients may help mitigate stroke complications.