Risk Factors for Cardiac Complications Following Primary Total Knee Arthroplasty: A National Database Analysis

Background: This study aimed to explore the incidence of cardiac complications including myocardial infarction, acute heart failure, and cardiogenic shock and identify associated risk factors during index hospitalization following total knee arthroplasty (TKA) using the National Inpatient Sample (NIS) database, with the goal of providing actionable insights to refine risk stratification protocols and optimize perioperative clinical decision-making. Methods: This national retrospective cohort study analyzed adults undergoing primary TKA between 2010 and 2019, excluding patients with preexisting cardiac conditions or prior knee surgeries to mitigate confounding. Utilizing the NIS, we identified risk factors for postoperative cardiac complications including myocardial infarction, acute heart failure, and cardiogenic shock occurring during index hospitalization following primary TKA through multivariate logistic regression analysis of demographics, hospital characteristics, preoperative comorbidities, and postoperative complications. Results: A total of 1,283,093 patients undergoing TKA were included in the analysis. The overall incidence of cardiac complications after TKA was 2.78% (n = 35,723). Advanced age, male sex, Black race, larger hospital size, teaching hospital status, and non-elective admissions were significant risk factors. Comorbidities, such as chronic pulmonary disease, hypertension, and chronic renal failure, were strongly associated with cardiac complications. Additionally, the occurrence of cardiac complications was associated with postoperative complications such as pneumonia, deep vein thrombosis, and arrhythmias. Conclusions: Cardiac complications after TKA were influenced by both patient-specific factors, such as age, sex, race, and comorbidities, and hospital-related factors, including hospital size and teaching status. Our analysis highlights the need for preoperative risk assessments and perioperative care, especially for high-risk patients with multiple comorbidities.