The incidence of acute myocardial infarction after elective spinal fusions or joint replacement surgery in the United States: a large-scale retrospective observational cohort study in 322,585 patients

Abstract

Background Acute myocardial infarction (AMI) is an uncommon but fatal complication among patients undergoing elective spinal fusion surgery (SF), total hip arthroplasty (THA), and total knee arthroplasty (TKA). Our objective was to estimate the incidence of AMI among adults undergoing elective SF, THA, and TKA in different post-operative risk windows and characterize high-risk sub-populations in the United States. Methods A retrospective cohort study was conducted using data from a longitudinal electronic healthcare record (EHR) database from January 1, 2007 to June 30, 2018. ICD codes were used to identify SF, THA, TKA, AMI, and selected clinical characteristics. Incidence proportions (IPs) and 95% confidence intervals were estimated in the following risk windows: index hospitalization, ≤ 30, ≤ 90, ≤ 180, and ≤ 365 days post-operation. Results A total of 67,533 SF patients, 87,572 THA patients, and 167,480 TKA patients were eligible for the study. The IP of AMI after SF, THA, and TKA ranged from 0.36, 0.28, and 0.25% during index hospitalization to 1.05, 0.93, and 0.85% ≤ 365 days post-operation, respectively. The IP of AMI was higher among patients who were older, male, with longer hospital stays, had a history of AMI, and had a history of diabetes. Conclusion The IP of post-operative AMI was generally highest among the SF cohort compared to the THA and TKA cohorts. Additionally, potential high-risk populations were identified. Future studies in this area are warranted to confirm these findings via improved confounder control and to identify effect measure modifiers.

Cerebrovascular Complications in Spinal Fusion Surgery: A Nationwide 8-year Follow-up Study in South Korea

“…Previous studies have suggested an association between spinal fusion and vascular-related conditions (Arena et al, 2021;Marquez-Lara et al, 2014;Xu et al, 2013). However, previous cohort studies have reported little or no significant association (Wu et al, 2012); thus, this topic remains controversial.…”

“…These elements combine to create a heightened risk of vascular complications following spinal fusion surgeries. Some studies have suggested an association between spinal fusion surgery and vascular-related conditions (Arena et al, 2021; Marquez-Lara et al, 2014; Reeg, 2001; Swann et al, 2016; Xu et al, 2013).…”

Loss of Bone Morphogenetic Protein-9 Reduces Survival and Increases MMP Activity After Myocardial Infarction

“…Myocardial infarction (MI) is a major cause of global morbidity and mortality that affects nearly 800,000 patients each year in the United States alone. 1 Cardiac wound healing after MI is a complex and multiphase process that begins with necrosis and apoptosis of cardiomyocytes due to ischemic injury with or without reperfusion followed by the formation of a fibrotic scar. 2 The acute phase of this process involves an inflammatory response and degradation of the extracellular matrix (ECM) followed by collagen synthesis, organization, and deposition within the first few weeks after MI.…”