Preoperative risk factors for postoperative cardiac arrest following primary total hip and knee arthroplasty: A large...

Area of Science:

• Orthopedic Surgery
• Cardiology
• Anesthesiology

Background:

• Cardiac arrest (CA) is a recognized complication of Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA).
• Preoperative comorbidities can influence patient outcomes following joint replacement surgery.
• Identifying risk factors is crucial for improving patient management and preventing adverse events.

Purpose of the Study:

• To identify independent risk factors associated with cardiac arrest (CA) following THA and TKA.
• To improve the management of patients undergoing THA or TKA with known preoperative comorbidities.
• To inform prophylactic strategies and update management guidelines for high-risk patients.

Main Methods:

• Retrospective, case-controlled study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2010-2017).
• Patients undergoing THA or TKA were identified using CPT codes.
• Multivariate logistic regression analysis was performed on patient samples with all covariates to assess independent associations with CA.

Main Results:

• For THA, independent risk factors for CA included perioperative transfusion, dyspnea (moderate exertion or at rest), dialysis, and age ≥72.
• For TKA, CA was associated with perioperative transfusion, anemia, bleeding disorders, dyspnea (moderate exertion), cardiac comorbidities, pulmonary comorbidities, and age ≥73.
• These factors were independently associated with increased rates of cardiac arrest.

Conclusions:

• Patients with identified risk factors face a higher risk of CA within 30 days post-THA or TKA.
• Recognizing these risk factors is essential for implementing prophylactic management strategies.
• Updating management guidelines for high-risk patients is imperative to prevent CA following joint replacement surgery.