Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures

• Published in: The Journal of arthroplasty Vol. 34; no. 4; pp. 743 - 749.e2
• Main Authors: Petersen, Pelle B., Kehlet, Henrik, Jørgensen, Christoffer C., Madsen, Frank, Hansen, Torben B., Husted, Henrik, Laursen, Mogens B., Hansen, Lars T., Kjærsgaard-Andersen, Per, Solgaard, Søren, Krarup, Niels Harry
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2019
• Subjects: Aged; Aged, 80 and over; Anemia - complications; Anticoagulants - adverse effects; arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Cohort Studies; Comorbidity; complication; Denmark - epidemiology; Elective Surgical Procedures; Female; Humans; Incidence; Length of Stay; Logistic Models; Male; Middle Aged; Odds Ratio; perioperative; postoperative; Registries; Risk Factors; stroke; Stroke - epidemiology; Stroke - etiology; Denmark; postoperative; perioperative; complication; stroke; arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2018.12.022

Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4%-0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA. We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population. Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11%; 95% confidence interval [CI], 0.08%-0.16%) and 43 strokes (0.17%, 95% CI, 0.13%-0.23%) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95% CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95% CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95% CI, 0.98-4.6, P = .055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population. Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.