Adult Surgery

New Risk Factors for Cardiovascular Problems After Joint Surgery Identified

Gina Gagua

August 19, 2008

In addition to confirming previously identified risk factors for cardiovascular complications after total joint replacement (TJR) surgery, researchers have shown that bilateral and revision operations are associated with increased risk.

"Revision joint replacement and bilateral surgery are much more prolonged operations than primary unilateral joint replacement," Dr. Jeffrey N. Katz, from Brigham and Women's Hospital in Boston, said in a statement. "These findings suggest an increased risk with more prolonged surgery."

The results, reported in the July issue of Arthritis and Rheumatism, come from a case-control study of 209 patients who experienced an MI, heart failure, unstable angina, arrhythmia, symptomatic hypotension, or pulmonary embolism during the surgical admission for TJR, and 209 matched patients who did not have cardiovascular complications.

In line with prior findings, older age at surgery (odds ratio, 1.7), history of arrhythmia (OR, 2.6), and history of coronary artery disease, MI, heart failure, or valvular heart disease (OR, 1.6) all increased the risk of cardiovascular complications.

The strongest risk factor, however, was one of the newly identified ones, bilateral surgery, which increased the risk by 3.5-fold. Revision surgery also greatly increased the risk (OR, 2.2).

"Clinicians can use this information to better estimate the risk of cardiovascular complications following TJR surgery," Dr. Katz said, "and, ultimately, to prevent and better manage these complications."

Arthritis Rheum 2008;58:1915-1920.

Reviewed by Ramaz Mitaishvili, MD

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