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151685 - pre-operative clinical predictors for cardiology referral.pdf (582.5 kB)

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

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posted on 2023-05-21, 10:33 authored by Elsiwy, Y, Symonds, T, Doma, K, Hazratwala, K, Matthew WilkinsonMatthew Wilkinson, Letson, H

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.

History

Publication title

Journal of Orthopaedic Surgery and Research

Volume

15

Article number

513

Number

513

Pagination

1-10

ISSN

1749-799X

Department/School

Tasmanian School of Medicine

Publisher

BioMed Central Ltd.

Place of publication

United Kingdom

Rights statement

© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License (https://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

Repository Status

  • Open

Socio-economic Objectives

Treatment of human diseases and conditions

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