A nationwide analysis of risk factors for in-hospital myocardial infarction after total joint arthroplasty

Abstract

Our findings can be used to better identify patients at high risk of AMI and to develop strategies aimed at diminishing its incidence, which could in turn translate to improved hospital efficiency and quality of care.

What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?

“…Timing was earlier in patients undergoing TKA for pulmonary embolism (day 3 [interquartile rage 2-6] versus 5 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17], p \ 0.001) and deep vein thrombosis (day 5 [2-11] versus 13 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], p \ 0.001) ( Table 3). Some adverse events were associated with certain baseline characteristics.…”

“…Long lists of risk factors have been identified for each of the common adverse events after total joint arthroplasty (TJA), including, for example, venous thromboembolism [16,17,21,24,31,36], surgical site infection [4,7,10,30], and myocardial infarction [1,13,15,18,35]. Although risk factors for postoperative adverse events are critical to understand, an important dimension that has received far less attention is the timing of adverse events.…”

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

“…We excluded patients whose source of admission was nonelective (eg, trauma) and patients who were transferred to another acute-care hospital [37]. To characterize the association of opioid abuse and dependence with in-hospital mortality, morbidity, and resource use after orthopaedic surgery, we identified patients with a diagnosis of opioidtype dependence (ICD-9-CM codes 304.0x, 304.7x) or nondependent opioid abuse (ICD-9-CM code 305.5x).…”

The impact of acute perioperative myocardial infarction on clinical outcomes after total joint replacement

“…8 Rates of acute myocardial infarction (MI) have been estimated around 0.25-1.9% after TJR; 6,7,9--11 having associations with greater comorbidity, longer hospital stays, and postoperative complication rates. 9 The risk factors for a myocardial event include advanced age, male sex, cardiac history, congestive heart failure, valvular disease, diabetes, coagulopathy, anemia, bilateral joint replacement, American Society of Anesthesiologists (ASA) classification rating of 3 or greater, and pulmonary circulation disorders. 6,7,9,11,12 Despite rigorous medical screening and optimization, this life threatening complication occurs usually within the expected 3 to 4 day hospital stay that is standard for joint replacement surgery.…”

“…9 The risk factors for a myocardial event include advanced age, male sex, cardiac history, congestive heart failure, valvular disease, diabetes, coagulopathy, anemia, bilateral joint replacement, American Society of Anesthesiologists (ASA) classification rating of 3 or greater, and pulmonary circulation disorders. 6,7,9,11,12 Despite rigorous medical screening and optimization, this life threatening complication occurs usually within the expected 3 to 4 day hospital stay that is standard for joint replacement surgery. 1,7 Interestingly, surgical experience and volume do not appear to affect mortality according to the existing literature.…”