Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the 'asymptomatic' patient.

Abstract

BACKGROUND:

No validated pre-operative cardiac risk stratification tool exists that is specific for total hip and total knee arthroplasty (THA and TKA, respectively). To reduce the risk of post-operative cardiac complication, surgeons need clear guidance on which patients are likely to benefit from pre-operative cardiac optimisation. This is particularly important for asymptomatic patients, where the need is harder to determine.

METHODS:

Primary THA and TKA performed between January 1, 2010, and December 31, 2017, were identified from a single orthopaedic practice. Over 25 risk factors were evaluated as predictors for patients requiring additional cardiac investigation beyond an ECG and echocardiogram, and for cardiac abnormality detected upon additional investigation. A multivariate logistic regression was conducted using significant predictor variables identified from inferential statistics. A series of predictive scores were constructed and weighted to identify the influence of each variable on the ability to predict the detection of cardiac abnormality pre-operatively.

RESULTS:

Three hundred seventy-four patients were eligible for inclusion. Increasing age (p < 0.001), history of cerebrovascular accident (p = 0.018), family history of cardiovascular disease (FHx of CVD) (p < 0.001) and decreased ejection fraction (EF) (p < 0.001) were significant predictors of additional cardiac investigation being required. Increasing age (p = 0.003), male gender (p = 0.042), FHx of CVD (p = 0.001) and a reduced EF (p < 0.001) were significantly predictive for the detection of cardiac abnormality upon additional cardiac investigation.

CONCLUSIONS:

Increasing age, male gender, FHx of CVD and decreased ejection fraction are important risk factors to consider for pre-operative cardiac optimisation in THA and TKA patients. These findings can be applied towards future predictive models, to determine which asymptomatic patients are likely to benefit from pre-operative cardiac referral.

• Authors: Yassin Elsiwy, Tristan Symonds, Kenji Doma, Kaushik Hazratwala, Matthew Wilkinson, Hayley Letson
• Journal: Journal of orthopaedic surgery and research (J Orthop Surg Res) Vol. 15 Issue 1 Pg. 513 (Nov 10 2020) ISSN: 1749-799X [Electronic] England
• PMID: 33168074 (Publication Type: Journal Article)

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip
• Arthroplasty, Replacement, Knee
• Asymptomatic Diseases
• Cardiology
• Female
• Heart Diseases (diagnosis, prevention & control)
• Humans
• Male
• Middle Aged
• Postoperative Complications (prevention & control)
• Predictive Value of Tests
• Preoperative Period
• Referral and Consultation
• Risk Factors
• Sex Factors
• Stroke Volume