• Mohammad R Rasouli, Reza Mostafavi Tabatabaee, Mitchell G Maltenfort, and Antonia F Chen.
• Investigation performed at the Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA.
• J Clin Anesth. 2016 Nov 1; 34: 15-20.

Study ObjectivesThis study aims to determine trends and predictors of acute stroke among total joint arthroplasty (TJA) patients using nationally representative data.DesignRetrospective database review.SettingNationwide Inpatient Sample database.PatientsA total of 1,762,496 TJAs from 2002 to 2011.InterventionsPatients underwent primary or revision total hip or total knee arthroplasty.MeasurementsDevelopment of perioperative acute stroke.Main ResultsAmong 1,762,496 TJAs, 2414 patients (0.14%) developed stroke; 1918 (79.45%) cases were ischemic and the remaining 496 (20.55%) cases were hemorrhagic stroke. The incidence of stroke decreased steadily from 0.17% in 2002 to 0.14% in 2011, which was statistically significant (P<.0001). The in-hospital mortality rate was much higher after stroke at 9% vs 0.15% for general TJA patients. Logistic regression analysis showed that stroke is a strong predictor of in-hospital mortality (odds ratio [OR], 27.73; 95% confidence interval [CI], 23.06-33.05; P<.001). Independent predictors of stroke were presence of pulmonary circulation disorders (including pulmonary embolism; OR, 2.23; 95% CI, 1.73-2.87), advanced diabetes mellitus (OR, 2.10; 95% CI, 1.61-2.73), cardiac arrhythmia (OR, 2.05; 95% CI, 1.83-2.29), peripheral vascular disease (OR, 1.74; 95% CI, 1.42-2.12), valvular heart disease (OR, 1.67; 95% CI, 1.43-1.95), renal disease (OR, 1.66; 95% CI, 1.38-1.99), and revision hip (OR, 1.39; 95% CI, 1.18-1.65). History of stroke or ischemic heart disease was not an independent predictor of stroke.ConclusionsDespite a decline in the rate of stroke and stroke-related mortality after TJA, stroke still seems to be a major cause of in-hospital mortality. The present study outlines some risk factors for stroke after TJA. Recognition of these factors and identification of the at-risk patients may allow for appropriate allocation of resources and ability to minimize this complication after TJA.Copyright © 2016 Elsevier Inc. All rights reserved.

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