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


Elsiwy, Y and Symonds, T and Doma, K and Hazratwala, K and Wilkinson, M and Letson, H, Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the 'asymptomatic' patient, Journal of Orthopaedic Surgery and Research, 15 Article 513. ISSN 1749-799X (2020) [Refereed Article]

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DOI: doi:10.1186/s13018-020-02042-5


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.

Item Details

Item Type:Refereed Article
Keywords:cardiac, arthroplasty, TKA, THA, risk factor, complication
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Surgery
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Wilkinson, M (Dr Matthew Wilkinson)
ID Code:151685
Year Published:2020
Web of Science® Times Cited:2
Deposited By:Medicine
Deposited On:2022-08-03
Last Modified:2022-08-03

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