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

Abstract

Purpose: Despite acute myocardial infarction (AMI) being a feared medical complication and currently a major cause of death after total hip and knee arthroplasty (THA/TKA), little is known about its peri-operative associated factors.

Methods: Data for this retrospective cohort study were extracted from the Nationwide Inpatient Sample for 2008-2011. Multivariate logistic regression modeling was performed to determine peri-operative factors associated with the development of inpatient AMI following THA/TKA.

Results: An estimated 3,096,791 procedures were identified. Perioperative AMI rates were 0.25 % for THA and 0.18 % for TKA. Patients with AMI had significantly greater comorbidity burden, higher peri-operative mortality rates, longer length of hospital stay and increased complication rates. Independent risk factors for the development of AMI comprised advance age, male gender [odds ratio (OR) 1.4, 95 % confidence interval (CI) 1.4-1.5], THA surgery (OR 1.3, 95 % CI 1.3-1.4), low household income (OR 1.3, 95 % CI 1.2-1.4), history of cardiac disease (coronary artery disease: OR 4.9, 95 % CI 4.6-5.2; congestive heart failure: OR 2.6, 95 % CI 2.4-2.8; valvular disease: OR 1.2, 95 % CI 1.1-1.3), diabetes (OR 1.1, 95 % CI 1.1-1.2), pulmonary circulation disorders (OR 1.4, 95 % CI 1.2-1.6), cerebrovascular disease (OR 2.3, 95 % CI 2.0-2.6), peripheral vascular disorders (OR 1.5, 95 % CI 1.4-1.7), coagulopathy (OR 1.4, 95 % CI 1.2-1.5), AIDS/HIV infection (OR 7.9, 95 % CI 4.5-13.9), deficiency anaemia (OR 1.4, 95 % CI 1.3-1.5), fluid and electrolyte disorders (OR 1.9, 95 % CI 1.8-2.0) and the occurrence of concomitant postoperative complications.

Conclusion: 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.