Introduction Bone cement implantation syndrome (BCIS) has been defined as complication of cementing implants that is characterized by intraoperative hypoxia and hypotension potentially leading to cardiac arrest and death. A BCIS grading system provides a score according to the severity of intraoperative vital sign changes. The purpose of this study was to investigate the predictive value of BCIS grade on 30-day and 1-year mortality in a modern patient cohort. Methods A retrospective review at a tertiary academic care center of all patients that underwent a total hip arthroplasty (THA) or hemiarthroplasty (HA) for acute femoral neck fracture between 2017–2024 was completed. Demographic and comorbidity data were recorded. Intraoperative anesthesia records were reviewed for vital sign changes and BCIS grade was calculated. Mortality data was collected through chart review, public obituaries, and patient phone calls. Data were analyzed using binary logistic regression and multivariate logistic regression. Results 418 patients met inclusion criteria. Of these, 197 patients were treated with THA (90 cemented stems, 107 cementless stems) and 221 patients treated with HA (204 cemented stems, 17 cementless stems). There were 125 patients with BCIS grade 0 (29.9%), 212 patients with BCIS grade 1 (50.7%), and 81 patients BCIS grade 2 (19.4%). No patients met criteria for BCIS grade 3 (complete cardiopulmonary collapse). The overall 30-day mortality was 14/418 (3.35%) and the 1-year mortality was 89/418 (21.29%). BCIS grade was not found to be associated with 30-day mortality (p=0.437) or 1-year mortality (p=0.902). Multivariate analysis showed that dementia (p=0.007) and HA (p=0.017) were associated with 30-day mortality, whereas CHF (p=0.040), aortic stenosis (p=0.033), COPD (p=0.047), cirrhosis (p=0.011), and CKD (p=0.023) were all associated with 1-year mortality. Conclusion BCIS grade was not predictive of 30-day or 1-year mortality in a modern cohort of patients undergoing THA or HA for femoral neck fracture.
Burke et al. (Thu,) studied this question.