Key result
Following elective total hip and knee arthroplasty, the overall 30-day stroke incidence was 0.09%, with age ≥80 years significantly increasing the risk of postoperative stroke (OR 16.1) compared to patients aged 18-59.
Why the study?
Postoperative stroke is a rare but devastating complication after total hip and knee arthroplasty, prompting this evaluation of its incidence, independent risk factors, and timing.
What is the incidence, timing, and predictors of 30-day postoperative stroke following elective primary THA and TKA?
Cohort (n=333,117)
Yes
What is the incidence, timing, and predictors of 30-day postoperative stroke following elective primary THA and TKA?
Odds Ratio: 16.1 (95% CI 7.89–32.88)
Absolute Event Rate: 0.25% vs 0.02%
p-value: p=<0.001
Postoperative stroke following elective THA and TKA is rare (0.09%) and occurs early, with older age, higher ASA score, and smoking identified as key risk factors.
Low stroke incidence after elective THA/TKA supports early postoperative vigilance; leaves open identification of modifiable predictors.
BACKGROUND: Postoperative stroke is a rare but potentially devastating complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of the current study was to determine the incidence, independent risk factors, and timing of stroke following THA and TKA utilizing the National Surgical Quality Improvement (NSQIP) database. METHODS: Patients who underwent elective primary THA and TKA were identified in the 2005-2016 NSQIP database. Thirty-day postoperative strokes were identified, timing was characterized, and an incidence curve was created. Multivariate analyses determined the independent predictors of these strokes. RESULTS: Of 333,117 patients identified, 286 (0.09%) experienced a stroke. Given that THA vs TKA was not a univariate predictor of stroke, the two procedures were considered together. The majority (65%) of strokes occurred before discharge. Of the strokes observed, 25% occurred by postoperative day one, 50% by postoperative day two, and 75% by postoperative day nine. Independent risk factors for postoperative stroke were: age (60-69 years old odds ratio [OR] = 4.2; 70-79 years old OR = 8.1; ≤80 years old OR = 16.1), higher American Society of Anesthesiologists (ASA) score (ASA≥3 OR = 1.7), and smoking [OR = 1.6). CONCLUSION: The incidence of stroke after THA/TKA was low at 0.09%, with the majority occurring prior to discharge and half occurring by postoperative day two. Patients who were older, sicker, or who were smokers were at greater risk of postoperative stroke. These findings can be used to council patients and to optimize patient care. LEVEL OF EVIDENCE: Level III, Retrospective comparative study.
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Haynes et al. (2020) conducted a cohort in Elective primary total hip and total knee arthroplasty (n=333,117). Age ≥80 years vs. Age 18-59 years was evaluated on 30-day postoperative stroke (OR 16.1, 95% CI 7.89-32.88, p=<0.001). Following elective total hip and knee arthroplasty, the overall 30-day stroke incidence was 0.09%, with age ≥80 years significantly increasing the risk of postoperative stroke (OR 16.1) compared to patients aged 18-59.
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