Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures

Pelle B. Petersen*, Henrik Kehlet, Christoffer C. Jørgensen, Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group, Frank Madsen (Member of study group), Torben B. Hansen (Member of study group), Henrik Husted (Member of study group), Mogens B. Laursen (Member of study group), Lars T. Hansen (Member of study group), Per Kjærsgaard-Andersen (Member of study group), Søren Solgaard (Member of study group), Niels Harry Krarup (Member of study group)

*Corresponding author

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4%-0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA. Methods: We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population. Results: Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11%; 95% confidence interval [CI], 0.08%-0.16%) and 43 strokes (0.17%, 95% CI, 0.13%-0.23%) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95% CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95% CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95% CI, 0.98-4.6, P =.055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population. Conclusion: Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.

Original languageEnglish
JournalJournal of Arthroplasty
Volume34
Issue number4
Pages (from-to)743-749.e2
Number of pages9
ISSN0883-5403
DOIs
Publication statusPublished - 1 Apr 2019

Fingerprint

Tacrine
Registries
Hip
Knee
Stroke
Incidence
Knee Replacement Arthroplasties
Confidence Intervals
Odds Ratio
Anticoagulants
Anemia
Perioperative Care
Clinical Studies
Ambulatory Surgical Procedures
Population
Medical Records
Observational Studies
Comorbidity
Length of Stay
Logistic Models

Keywords

  • arthroplasty
  • complication
  • perioperative
  • postoperative
  • stroke

Cite this

Petersen, P. B., Kehlet, H., Jørgensen, C. C., Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group, Madsen, F., Hansen, T. B., ... Krarup, N. H. (2019). Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures. Journal of Arthroplasty, 34(4), 743-749.e2. https://doi.org/10.1016/j.arth.2018.12.022
Petersen, Pelle B. ; Kehlet, Henrik ; Jørgensen, Christoffer C. ; Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group ; Madsen, Frank ; Hansen, Torben B. ; Husted, Henrik ; Laursen, Mogens B. ; Hansen, Lars T. ; Kjærsgaard-Andersen, Per ; Solgaard, Søren ; Krarup, Niels Harry. / Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures. In: Journal of Arthroplasty. 2019 ; Vol. 34, No. 4. pp. 743-749.e2.
@article{faabd804c3b440638778cdfa91e38ee8,
title = "Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures",
abstract = "Background: Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4{\%}-0.6{\%} after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA. Methods: We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population. Results: Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11{\%}; 95{\%} confidence interval [CI], 0.08{\%}-0.16{\%}) and 43 strokes (0.17{\%}, 95{\%} CI, 0.13{\%}-0.23{\%}) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95{\%} CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95{\%} CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95{\%} CI, 0.98-4.6, P =.055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population. Conclusion: Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.",
keywords = "arthroplasty, complication, perioperative, postoperative, stroke",
author = "Petersen, {Pelle B.} and Henrik Kehlet and J{\o}rgensen, {Christoffer C.} and {Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group} and Frank Madsen and Hansen, {Torben B.} and Henrik Husted and Laursen, {Mogens B.} and Hansen, {Lars T.} and Per Kj{\ae}rsgaard-Andersen and S{\o}ren Solgaard and Krarup, {Niels Harry}",
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Petersen, PB, Kehlet, H, Jørgensen, CC, Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group, Madsen, F, Hansen, TB, Husted, H, Laursen, MB, Hansen, LT, Kjærsgaard-Andersen, P, Solgaard, S & Krarup, NH 2019, 'Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures', Journal of Arthroplasty, vol. 34, no. 4, pp. 743-749.e2. https://doi.org/10.1016/j.arth.2018.12.022

Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures. / Petersen, Pelle B.; Kehlet, Henrik; Jørgensen, Christoffer C.; Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group; Madsen, Frank (Member of study group); Hansen, Torben B. (Member of study group); Husted, Henrik (Member of study group); Laursen, Mogens B. (Member of study group); Hansen, Lars T. (Member of study group); Kjærsgaard-Andersen, Per (Member of study group); Solgaard, Søren (Member of study group); Krarup, Niels Harry (Member of study group).

In: Journal of Arthroplasty, Vol. 34, No. 4, 01.04.2019, p. 743-749.e2.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures

AU - Petersen, Pelle B.

AU - Kehlet, Henrik

AU - Jørgensen, Christoffer C.

AU - Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group

A2 - Madsen, Frank

A2 - Hansen, Torben B.

A2 - Husted, Henrik

A2 - Laursen, Mogens B.

A2 - Hansen, Lars T.

A2 - Kjærsgaard-Andersen, Per

A2 - Solgaard, Søren

A2 - Krarup, Niels Harry

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4%-0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA. Methods: We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population. Results: Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11%; 95% confidence interval [CI], 0.08%-0.16%) and 43 strokes (0.17%, 95% CI, 0.13%-0.23%) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95% CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95% CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95% CI, 0.98-4.6, P =.055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population. Conclusion: Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.

AB - Background: Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4%-0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA. Methods: We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population. Results: Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11%; 95% confidence interval [CI], 0.08%-0.16%) and 43 strokes (0.17%, 95% CI, 0.13%-0.23%) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95% CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95% CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95% CI, 0.98-4.6, P =.055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population. Conclusion: Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.

KW - arthroplasty

KW - complication

KW - perioperative

KW - postoperative

KW - stroke

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U2 - 10.1016/j.arth.2018.12.022

DO - 10.1016/j.arth.2018.12.022

M3 - Journal article

VL - 34

SP - 743-749.e2

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

SN - 0883-5403

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Petersen PB, Kehlet H, Jørgensen CC, Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group, Madsen F, Hansen TB et al. Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty—A Clinical Registry Study of 24,862 Procedures. Journal of Arthroplasty. 2019 Apr 1;34(4):743-749.e2. https://doi.org/10.1016/j.arth.2018.12.022