Atrial Septal Defect Increases the Risk for Stroke After Total Hip Arthroplasty
| Autor: | Matthew R. Boylan, Qais Naziri, Michael A. Mont, Morad Chughtai, Dean C. Perfetti, Aditya V. Maheshwari |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Arthroplasty Replacement Hip Population Foramen Ovale Patent Comorbidity 030204 cardiovascular system & hematology Logistic regression Risk Assessment Brain Ischemia 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors mental disorders Odds Ratio medicine Humans Orthopedics and Sports Medicine education Stroke Aged education.field_of_study business.industry Perioperative medicine.disease United States Surgery Logistic Models Case-Control Studies Propensity score matching Orthopedic surgery Patent foramen ovale Female Diagnosis code business 030217 neurology & neurosurgery |
| Zdroj: | The Journal of Arthroplasty. 32:3152-3156 |
| ISSN: | 0883-5403 |
| DOI: | 10.1016/j.arth.2017.05.006 |
| Popis: | Atrial septal defect (ASD) and patent foramen ovale (PFO) are 2 of the most common congenital heart diseases in adults and pose important risks of perioperative acute ischemic stroke (AIS) from paradoxical emboli. We evaluated the following: (1) the prevalence of ASD/PFO in the total hip arthroplasty (THA) population; (2) the rate of perioperative AIS during index admissions; and (3) the risk for perioperative AIS after THA for patients with ASD/PFO vs matched controls.We identified 393,652 patients in the Nationwide Inpatient Sample who underwent THA between January 1, 2007, and December 31, 2013. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes were used to identify patients with ASD/PFO and perioperative AIS. Propensity scores matched 252 patients with ASD/PFO to 756 controls (3:1 ratio) without ASD/PFO according to age, gender, race, Deyo comorbidity score, year of surgery, and stroke risk factors. Logistic regression models assessed risk for perioperative AIS.The prevalence of ASD/PFO was 64 per 100,000 THA patients. The rate of perioperative AIS was 99 per 100,000 THA in the general THA population. The rate of perioperative AIS was 7.14% for ASD/PFO patients compared with 0.26% in matched controls (P.001). Risk for perioperative AIS was 29 times greater for patients with ASD/PFO compared with matched controls (odds ratio, 29.00; 95% confidence interval, 6.68-125.89; P.001).Patients with ASD/PFO undergoing THA are at a significantly higher risk of perioperative AIS. Orthopedic surgeons should discuss this risk with patients before surgery. The efficacy of mechanical and pharmacologic thromboprophylactic measures to reduce perioperative AIS among ASD/PFO patients warrants further investigation. |
| Databáze: | OpenAIRE |
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