Acute stroke after total joint arthroplasty: a population-based trend analysis.
STUDY OBJECTIVES
This study aims to determine trends and predictors of acute stroke among total joint arthroplasty (TJA) patients using nationally representative data.


DESIGN
Retrospective database review.


SETTING
Nationwide Inpatient Sample database.


PATIENTS
A total of 1,762,496 TJAs from 2002 to 2011.


INTERVENTIONS
Patients underwent primary or revision total hip or total knee arthroplasty.


MEASUREMENTS
Development of perioperative acute stroke.


MAIN RESULTS
Among 1,762,496 TJAs, 2414 patients (0.14%) developed stroke; 1918 (79.45%) cases were ischemic and the remaining 496 (20.55%) cases were hemorrhagic stroke. The incidence of stroke decreased steadily from 0.17% in 2002 to 0.14% in 2011, which was statistically significant (P<.0001). The in-hospital mortality rate was much higher after stroke at 9% vs 0.15% for general TJA patients. Logistic regression analysis showed that stroke is a strong predictor of in-hospital mortality (odds ratio [OR], 27.73; 95% confidence interval [CI], 23.06-33.05; P<.001). Independent predictors of stroke were presence of pulmonary circulation disorders (including pulmonary embolism; OR, 2.23; 95% CI, 1.73-2.87), advanced diabetes mellitus (OR, 2.10; 95% CI, 1.61-2.73), cardiac arrhythmia (OR, 2.05; 95% CI, 1.83-2.29), peripheral vascular disease (OR, 1.74; 95% CI, 1.42-2.12), valvular heart disease (OR, 1.67; 95% CI, 1.43-1.95), renal disease (OR, 1.66; 95% CI, 1.38-1.99), and revision hip (OR, 1.39; 95% CI, 1.18-1.65). History of stroke or ischemic heart disease was not an independent predictor of stroke.


CONCLUSIONS
Despite a decline in the rate of stroke and stroke-related mortality after TJA, stroke still seems to be a major cause of in-hospital mortality. The present study outlines some risk factors for stroke after TJA. Recognition of these factors and identification of the at-risk patients may allow for appropriate allocation of resources and ability to minimize this complication after TJA.
['Rasouli|Mohammad R|MR|', 'Tabatabaee|Reza Mostafavi|RM|', 'Maltenfort|Mitchell G|MG|', 'Chen|Antonia F|AF|']
D001145:Arrhythmias, Cardiac D019644:Arthroplasty, Replacement, Hip D019645:Arthroplasty, Replacement, Knee D048909:Diabetes Complications D006349:Heart Valve Diseases D017052:Hospital Mortality D006801:Humans D015994:Incidence D007674:Kidney Diseases D059035:Perioperative Period D016491:Peripheral Vascular Diseases D011655:Pulmonary Embolism D012086:Reoperation D012189:Retrospective Studies D012307:Risk Factors D020521:Stroke D014481:United States
Stroke Total joint arthroplasty Nationwide Inpatient Sample