Are Patients with Cardiovascular Disease at Higher Risk for Postoperative Complications following Total Hip or Total Knee Replacements? A Retrospective Cohort Study

Background: Cardiovascular disease affects 121.5 million Americans, or 48% of the adult US population and is the leading cause of death in the United States. The demand for total joint replacement is expected to increase due to an aging population and advances in technology. Given the prevalence of cardiovascular disease and the expected increase in total joint replacement procedures, we sought to examine whether cardiovascular disease was associated with increased postoperative complications in patients undergoing total hip and knee replacements.Methods:CPT codes were used to investigate the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent total hip or knee replacements from 2010 to 2017. Patients were classified as having cardiovascular disease as per the American Health Association guidelines. Patient samples with all possible covariates were included in a multivariate logistic regression analysis. A patient sample size of 119,076 for total hip and 189,297 for total knee replacement was analyzed.Results: Patients with cardiovascular disease were found to have a statistically significant increased risk for the following postoperative complications: sepsis, wound complications, pneumonia, urinary tract infection, myocardial infarction, unplanned intubation, and cardiac arrest. Conclusions: Patients with cardiovascular disease undergoing a total hip or knee replacement have increased risk for wound, infectious and cardiovascular-associated postoperative complications. This finding necessitates the need for more frequent and sooner postoperative visits, a stringent cardiovascular preoperative evaluation, and patient education on the increased postoperative risks of joint replacements to lower the incidence of complications.