Risk Factors for Post-Operative Stroke Following Total Hip Arthroplasty

Post-operative stroke following a total hip arthroplasty (THA) is relatively uncommon but remains a feared complication. This study completes both a univariate and multivariate analysis on independent conditions leading to postoperative stroke following THA.

The American College of Surgeons: National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for THA cases between 2017 to 2021 (CPT code 27130).Demographic, comorbid, diagnostic and preoperative laboratory values were investigated to decipher predictors of postoperative stroke. A statistical significance value of p<0.05 was used in evaluation.

This analysis included 199,960 patients. In the initial univariate analysis for postoperative stroke, significant variables were age (p < 0.0001), and use of general anesthesia (p = 0.0249) and BMI (p = 0.0050). Diabetes (p = 0.7481), functional dependence (p = 0.8556), COPD (p = 0.6589), CHF (p = 0.9748), dialysis (p = 0.1136), and Frailty index (p = 0.8543) were not significant. The univariate variables age and general anesthesia remained significant in the multivariate analysis. However, upon removal of the frailty index due to its overlap with functional status, smoking status (p = 0.0210), and operation time (p = 0.0265) became statistically significant in the multivariate model.

This national cohort study found that the risk of postoperative stroke following total hip arthroplasty is associated with older age and having the procedure under general anesthesia in both univariate and multivariate analysis. When the frailty index was removed from analysis (due to its conceptual overlap with functional status), postoperative stroke after THA was also associated with smoking status and the duration of the operation.