Risk factors for 30-day major adverse cardiovascular events after primary total hip arthroplasty: A national cohort study

Background: Total hip arthroplasty (THA) is a commonly performed orthopedic procedure and is associated with low complication rates. However, major adverse cardiovascular events (MACE) remain a rare but serious postoperative risk. Prior studies have been limited by incomplete adjustment or narrow outcome definitions. We aimed to identify independent predictors of 30-day MACE following primary THA using a large, national surgical database. Methods: We conducted a retrospective cohort study using ACS NSQIP data from 2018–2022, identifying adult patients undergoing primary THA. The primary outcome was 30-day MACE, defined as a composite of postoperative death, myocardial infarction, cardiac arrest, stroke, pulmonary embolism, or deep vein thrombosis. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for MACE, adjusting for demographic, comorbidity, functional, and operative covariates. Results: Among 206,925 patients, the overall incidence of MACE was 0.3%. Advanced age was associated with progressively higher odds of MACE, including age 65–74 (aOR 1.81, 95% CI 1.41–2.31) and ≥80 years (aOR 3.66, 95% CI 2.81–4.75). Diabetes (aOR 1.29, 95% CI 1.15–1.44), COPD (aOR 1.52, 95% CI 1.30–1.79), and heart failure (aOR 1.78, 95% CI 1.44–2.20) were associated with increased odds of MACE, as was functional dependence. Outpatient surgery (aOR 0.51, 95% CI 0.45–0.58) and class II–III obesity were associated with lower odds. After adjustment for COPD, current smoking was not independently associated with MACE (aOR 0.99, 95% CI 0.85–1.15). Conclusion: Key demographic, medical, and functional factors predict postoperative cardiovascular risk following THA. These findings may enhance preoperative risk stratification and support targeted strategies to reduce MACE in higher-risk patients.