Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the ‘asymptomatic’ patient

Abstract

Background No validated pre-operative cardiac risk stratification tool exists that is specific for total hip and total knee arthroplasty (THA and TKA, respectively). To reduce the risk of post-operative cardiac complication, surgeons need clear guidance on which patients are likely to benefit from pre-operative cardiac optimisation. This is particularly important for asymptomatic patients, where the need is harder to determine. Methods Primary THA and TKA performed between January 1, 2010, and December 31, 2017, were identified from a single orthopaedic practice. Over 25 risk factors were evaluated as predictors for patients requiring additional cardiac investigation beyond an ECG and echocardiogram, and for cardiac abnormality detected upon additional investigation. A multivariate logistic regression was conducted using significant predictor variables identified from inferential statistics. A series of predictive scores were constructed and weighted to identify the influence of each variable on the ability to predict the detection of cardiac abnormality pre-operatively. Results Three hundred seventy-four patients were eligible for inclusion. Increasing age (p < 0.001), history of cerebrovascular accident (p = 0.018), family history of cardiovascular disease (FHx of CVD) (p < 0.001) and decreased ejection fraction (EF) (p < 0.001) were significant predictors of additional cardiac investigation being required. Increasing age (p = 0.003), male gender (p = 0.042), FHx of CVD (p = 0.001) and a reduced EF (p < 0.001) were significantly predictive for the detection of cardiac abnormality upon additional cardiac investigation. Conclusions Increasing age, male gender, FHx of CVD and decreased ejection fraction are important risk factors to consider for pre-operative cardiac optimisation in THA and TKA patients. These findings can be applied towards future predictive models, to determine which asymptomatic patients are likely to benefit from pre-operative cardiac referral.

Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization

“…Cardiovascular events are among the most frequent postoperative complications following TJA (Elsiwy et al, 2020; Featherall et al, 2018). Cardiovascular health is also closely tied to other independent risk factors such as obesity and uncontrolled diabetes (Featherall et al, 2018; Fournier et al, 2016), which may predispose patients to CVD.…”

Cardiovascular Disease in Total Knee Arthroplasty: An Analysis of Hospital Outcomes, Complications, and Mortality

“… 19 20) Even in asymptomatic individuals without known preexisting disease, increasing age has been identified as a risk factor for the detection of a cardiac abnormality (i.e., heart block, ectopic beat) before total joint arthroplasty. 21) Multiple studies have also linked advanced age with an increased predilection for diabetes, pulmonary disease, and adverse outcomes including prolonged LOS and mortality. 7 21 22 23 24 25) As the average age of patients undergoing TKA increases, one must be aware of its operative implications, which may support a more prudent preoperative clearance with a lower threshold for preoperative cardiology referral.…”

“… 21) Multiple studies have also linked advanced age with an increased predilection for diabetes, pulmonary disease, and adverse outcomes including prolonged LOS and mortality. 7 21 22 23 24 25) As the average age of patients undergoing TKA increases, one must be aware of its operative implications, which may support a more prudent preoperative clearance with a lower threshold for preoperative cardiology referral. 21) …”

“… 7 21 22 23 24 25) As the average age of patients undergoing TKA increases, one must be aware of its operative implications, which may support a more prudent preoperative clearance with a lower threshold for preoperative cardiology referral. 21) …”

Rehabilitation nach Hüftendoprothese

“…Etwa jeder dritte Gelenkersatzkandidat hat präoperativ ein auffälliges EKG wie z. B. einen AV-Block, Vorhofflimmern oder einen Hinweis auf ein früheres ischämisches Ereignis [3].…”