Elsevier

American Heart Journal

Volume 165, Issue 3, March 2013, Pages 427-433.e1
American Heart Journal

Clinical Investigation
Surgery
Thrombotic and bleeding complications after orthopedic surgery

https://doi.org/10.1016/j.ahj.2012.11.005Get rights and content

Background

Thrombotic and bleeding complications are major concerns during orthopedic surgery. Given the frequency of orthopedic surgical procedures and the limited data in the literature, we sought to investigate the incidence and risk factors for thrombotic (myocardial necrosis and infarction) and bleeding events in patients undergoing orthopedic surgery.

Methods and Results

We performed a retrospective cohort analysis of 3,082 consecutive subjects ≥21 years of age undergoing hip, knee, or spine surgery between November 1, 2008, and December 31, 2009. Patient characteristics were ascertained using International Classification of Diseases, Ninth Revision, diagnosis coding and retrospective review of medical records, and laboratory/blood bank databases. In-hospital outcomes included myocardial necrosis (elevated troponin), major bleeding, coded myocardial infarction, and coded hemorrhage as defined by International Classification of Diseases, Ninth Revision, coding. Of the 3,082 subjects, mean age was 60.8 ± 13.3 years, and 59% were female. Myocardial necrosis, coded myocardial infarction, major bleeding, and coded hemorrhage occurred in 179 (5.8%), 20 (0.7%), 165 (5.4%), and 26 (0.8%) subjects, respectively. Increasing age (P < .001), coronary artery disease (P < .001), cancer (P = .004), and chronic kidney disease (P = .01) were independent predictors of myocardial necrosis, whereas procedure type (P < .001), cancer (P < .001), female sex (P < .001), coronary artery disease (P < .001), and chronic obstructive pulmonary disease (P = .01) were independent predictors of major bleeding.

Conclusion

There is a delicate balance between thrombotic and bleeding events in the perioperative period after orthopedic surgery. Perioperative risk of both thrombosis and bleeding deserves careful attention in preoperative evaluation, and future prospective studies aimed at attenuating this risk are warranted.

Section snippets

Study design

We performed a retrospective cohort analysis of 3,294 consecutive subjects at a tertiary care academic medical center between November 1, 2008, and December 31, 2009. Patients >21 years of age who underwent hip, knee, or spine surgery were eligible. Two hundred twelve subjects <21 years of age were excluded leaving 3,082 subjects in this cohort. This study was approved by the institutional review board with an informed consent waiver.

Data sources

Data for this study were obtained from the hospital

Overall population

A total of 3,082 subjects who underwent orthopedic surgery of the spine (38%), knee (33%), and hip (30%) were included. Baseline characteristics are described in Table I. The mean age of the cohort was 60.8 ± 13.3 years, 59% were female, and 65% were white. A history of CAD was present in 327 subjects (11%). Forty-nine percent of subjects had a history of hypertension; 15%, diabetes; 3%, kidney disease; 2%, cancer; and 1%, peripheral vascular disease.

Adverse perioperative events are recorded in

Discussion

There have been few studies on thrombotic and bleeding complications after orthopedic surgery. This lack of information complicates the preoperative evaluation and makes it difficult to assess the thrombotic and bleeding risks of surgery. Furthermore, differences in both the study population and the definitions used for thrombotic and bleeding complications limit the comparison between studies. Our study showed an overall incidence of myocardial necrosis and major bleeding of 5.8% and 5.4%,

Disclosures

There are no conflicts of interest for any of the submitting authors.

Acknowledgements

Dr Berger was partially funded by an American Heart Association Fellow to Faculty Award (0775074N) and a Doris Duke Clinical Scientist Award (2010055).

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    Hartzell V. Schaff, MD served as guest editor for this article.

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