نبذة مختصرة : 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.
Relation: https://doi.org/10.1186/s13018-020-02042-5; https://researchonline.jcu.edu.au/65004/; https://researchonline.jcu.edu.au/65004/1/Pre-operative%20Clinical%20Predictors%20for%20Cardiology%20Referral%20Prior%20to%20Total%20Joint%20Arthroplasty-%20the%20%27asymptomatic%27%20patient.pdf; Elsiwy, Yassin, Symonds, Tristan, Doma, Kenji, Hazratwala, Kaushik, Wilkinson, Matthew, and Letson, Hayley (2020) Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the 'asymptomatic' patient. Journal of Orthopaedic Surgery and Research, 15. 513.
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