Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

Abstract

Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

Incidence and risk factors for stroke after hip fracture: a meta-analysis

“…Variability in hypertension prevalence, age distribution, and research settings could explain these disparities. Similarly, Atzmon et al 10 and He et al 18 identified atrial fibrillation as an independent predictor of post-fracture stroke; however, this meta-analysis found a non-significant trend 10 , 18 . These discrepancies again highlight that the synthesized data may fail to capture the nuanced effects detectable in higher-quality primary studies.…”

“…Although hypertension, heart disease, atrial fibrillation, and renal insufficiency were not statistically significant predictors of stroke, understanding the nuances of an individual patient's comorbidity profile can still help guide personalized prevention tactics 29 . Low serum albumin levels have emerged as a potential novel biomarker for heightened stroke risk and warrants further research 18 . The incorporation of albumin testing into hip fracture care pathways may be useful in risk stratification.…”

“…In individual studies, there were additional risk factors, such as D-dimer or hyperlipidemia 18 . Studies with shorter follow-up periods have established a lower rate of stroke 19 , 24 .…”

Comparison of risk of complication between neuraxial anaesthesia and general anaesthesia for hip fracture surgery: a systematic review and meta-analysis

“…Surgical treatment is required in most patients who sustain hip fractures 4 , 5 . The choice of anaesthesia technique is crucial because it significantly influences the recovery after surgery and the risk of complications, especially in older patients 6 . However, the optimal anaesthetic technique for elderly patients with hip fracture has remained controversial for decades 7 .…”