The Total Joint Arthroplasty Cardiac Risk Index for Predicting Perioperative Myocardial Infarction and Cardiac Arrest After Primary Total Knee and Hip Arthroplasty

The Journal of Arthroplasty
Brian R WatermanAndrew J Schoenfeld

Abstract

Current indices fail to consistently predict risk for major adverse cardiac events after major total joint arthroplasty. All primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified from the National Surgical Quality Improvement Program data set. Based on prior analyses, age ≥80 years, history of hypertension, and history of cardiac disease were evaluated as predictors of myocardial infarction and cardiac arrest using stepwise multivariate logistic regression. A series of predictive scores were constructed and weighted to identify the influence of each variable on 30-day postoperative cardiac events, while comparing with the Revised Cardiac Risk Index (RCRI). Among 85,129 patients, age ≥80 years, hypertension, and a history of cardiac disease were all statistically significant predictors of postoperative cardiac events (0.32%; n = 275) after TKA and THA (P ≤ .02). Equal weighting of all variables maintained the highest discriminative capacity in both THA and TKA cohorts. Adjusted models explained 75% and 71% of the variation in postoperative cardiac events for those with THA and TKA, respectively, without statistically significant lack of fit (P = .52; P = .23, respectively). Conversely, the RCRI w...Continue Reading

References

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Citations

May 25, 2005·Clinics in Geriatric Medicine·C Allyson JonesMaria E Suarez-Almazor
Jan 13, 2019·Journal of Orthopaedic Surgery and Research·Yassin ElsiwyHayley Letson
Jun 15, 2019·BMC Anesthesiology·Anna-Maria BurgdorffDavid Wohlrab
Jul 1, 2017·Current Reviews in Musculoskeletal Medicine·Forrest H Schwartz, Jeffrey Lange
Nov 11, 2020·Journal of Orthopaedic Surgery and Research·Yassin ElsiwyHayley Letson
Oct 10, 2020·The Journal of Arthroplasty·Chad A KruegerMatthew S Austin
Aug 17, 2021·The Journal of Bone and Joint Surgery. American Volume·Edward S HurTad L Gerlinger

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