The risk of venous thromboembolism, myocardial infarction, stroke, major bleeding and death in patients undergoing total hip and knee replacement

Abstract

We examined the risk of thrombotic and major bleeding events in patients undergoing total hip and knee replacement (THR and TKR) treated with thromboprophylaxis, using nationwide population-based databases. We identified 83 756 primary procedures performed between 1997 and 2011. The outcomes were symptomatic venous thromboembolism (VTE), myocardial infarction (MI), stroke, death and major bleeding requiring hospitalisation within 90 days of surgery. A total of 1114 (1.3%) and 483 (0.6%) patients experienced VTE and bleeding, respectively. The annual risk of VTE varied between 0.9% and 1.6%, and of bleeding between 0.4% and 0.8%. The risk of VTE and bleeding was unchanged over a 15-year period. A total of 0.7% of patients died within 90 days, with a decrease from 1% in 1997 to 0.6% in 2011 (p < 0.001). A high level of comorbidity and general anaesthesia were strong risk factors for both VTE and bleeding, with no difference between THR and TKR patients. The risk of both MI and stroke was 0.5%, which remained unchanged during the study period. In this cohort study of patients undergoing THR and TKR patients in routine clinical practice, approximately 3% experienced VTE, MI, stroke or bleeding. These risks did not decline during the 15-year study period, but the risk of dying fell substantially.

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

“…Postoperative stroke rates have varied depending on research methodology and surgical population and have remained stable despite surgical advances, potentially reflecting an aging population with increasing concomitant comorbidities [30,37]. Unfortunately, relatively few orthopaedic studies have examined perioperative cerebrovascular events [11,22,24,29,32]. We therefore sought to assess the rates and predictors of CVA after common elective inpatient orthopaedic procedures to provide physicians a more accurate glimpse of this potential morbidity.…”

“…CVA timing (day of CVA event after surgery and pre-versus postdischarge events) also was recorded. Preoperative and operative variables were captured for each patient, including those previously shown to be associated with perioperative stroke, such as age, prior history of CVA, hypertension, diabetes, prior myocardial infarction, congestive heart failure, and general anesthesia (Table 1) [22,24,29,32,38].…”

“…The perioperative period places patients at an even greater risk of CVA owing to surgery-induced hypercoagulability, general anesthesia, dehydration, stasis and bed rest, and withholding administration of preoperative antiplatelet and anticoagulation agents [38]. Despite advances in surgical techniques and perioperative care, the incidence of stroke has remained stable, varying by the type and complexity of operative intervention [16,22,29,32,37].…”

Mortality following primary total knee replacement in public hospitals in Hong Kong

“…[1][2][3][4][5][6][7][8] Risk factors for post-TKR mortality include age at operation, male sex, too high or low body mass index, American Society of Anesthesiologists (ASA) class 3 to 4, presence of co-morbidities, and simultaneous bilateral surgery. [1][2][3][4][6][7][8][9][10][11][12] There are a lack of similar data for the Asian population, however, and the risk of mortality in a high-volume hospital has not been described locally.…”

“…These compared favourably with data of large national joint registries of other countries: 0.2% to 0.4%, 0.4% to 0.7%, and 1% to 2%, respectively. [1][2][3][4][5][6][7][8] There is no definitive explanation for such findings but several possibilities exist. First, TKR is still mostly considered a 'risky' and major operation in Hong Kong such that the popularity of such surgery remains low compared with other countries.…”