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Atrial Septal Defect Increases the Risk for Stroke After Total Hip Arthroplasty

Dean C Perfetti1, Morad Chughtai2, Matthew R Boylan3

  • 1Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.

The Journal of Arthroplasty
|June 13, 2017
PubMed

Insights

Patients with atrial septal defect (ASD) or patent foramen ovale (PFO) undergoing total hip arthroplasty (THA) face a significantly higher risk of perioperative acute ischemic stroke (AIS). This highlights the need for pre-operative risk discussion.

Area of Science:

  • Cardiology
  • Orthopedic Surgery
  • Neurology

Background:

  • Atrial septal defect (ASD) and patent foramen ovale (PFO) are common congenital heart conditions.
  • These defects pose risks for perioperative acute ischemic stroke (AIS) via paradoxical emboli.

Purpose of the Study:

  • To determine ASD/PFO prevalence in total hip arthroplasty (THA) patients.
  • To assess perioperative AIS rates in THA patients with ASD/PFO.
  • To compare AIS risk in THA patients with ASD/PFO versus controls.

Main Methods:

  • Analysis of 393,652 THA patients from the Nationwide Inpatient Sample (2007-2013).
  • Identification of ASD/PFO and perioperative AIS using ICD-9-CM codes.
  • Propensity score matching of 252 ASD/PFO patients with 756 controls.

Main Results:

  • ASD/PFO prevalence was 64 per 100,000 THA patients.
  • AIS rate was 7.14% in ASD/PFO patients vs. 0.26% in controls (P < .001).
  • ASD/PFO increased AIS risk by 29-fold (OR, 29.00; P < .001).

Conclusions:

  • THA patients with ASD/PFO have substantially elevated perioperative AIS risk.
  • Orthopedic surgeons must discuss this risk pre-operatively.
  • Further research is needed on thromboprophylaxis for ASD/PFO patients.
Abstract

Keywords:
Nationwide Inpatient Sampleacute ischemic strokeatrial septal defectpatent foramen ovaletotal hip arthroplasty

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