Gastrointestinal Bleeds Are a Rare Event After Total Hip and Knee Arthroplasty

The presence of a gastrointestinal (GI) bleed after elective total hip arthroplasty and total knee arthroplasty (THA and TKA, respectively) is concerning and a potential cause for hospital readmission. This condition can also be life-threatening if not identified and treated appropriately. Many surgeons use multimodal analgesia protocols to limit opioid use and also use venous thromboembolism prophylaxis. Aspirin and nonsteroidal anti-inflammatories, often a component of these protocols, reduce prostaglandin production necessary for gastric mucosal protection. The authors hypothesized that the incidence of a GI bleed after TKA and THA would be rare.

This was a retrospective review of 8,207 patients 18 years or older who had THA or TKA at a single institution between 2015 and 2022. Patients who were evaluated for GI bleed within 90 days postoperatively were identified. Perioperative risks were analyzed based on demographics, procedures, and other risk factors.

The incidence of GI bleeding was 0.33%, in which 27 patients sustained a GI bleed in 8,206 THA and TKA cases. The average days from the time of surgery for GI bleed were 18.6 days. There was a difference in the occurrence of GI bleeds by age, with increasing age being positively associated with an increase in the odds of GI bleeds, odds ratio = 1.15 (95% CI [confidence interval]: 1.09 to 1.21), P < 0.01. No statistical difference was found based on other demographic data, procedure type, or site.

This institution's perioperative protocol, including the use of nonsteroidal anti-inflammatories and aspirin for TKA and THA, had a low incidence of GI bleeds in the perioperative setting at our community hospital over the course of 2015 to 2022.