Incidence and Predictors of Stroke after Hip Surgery

Background:

Hip surgery (either total hip arthroplasty or repair of the fracture) is the most common noncardiac surgical procedure performed in patients 65 years or older. Most postoperative complication reports have focused on cardiac events and their prevention, but little is known about stroke after hip surgery or interventions to reduce such events. The objectives of this study were to estimate the incidence of stroke within 1 year following hip surgery among Olmsted County residents from 1988 to 2002 and to identify predictors of postoperative stroke after hip surgery.

Methods:

The study was a population‐based retrospective cohort of Olmsted County, Minnesota, residents who underwent hip surgery .Baseline clinical characteristics were obtained from the medical record. A multivariable model built from significant variables in univariate analysis evaluated independent risk factors for postoperative stroke. Measurements were ischemic or hemorrhagic stroke within the first year postoperatively after hip surgery. Strokes were identified by medical record review for stroke diagnostic codes and brain imaging (CT, MRI), and subsequently stroke was confirmed by physician review of the recorded event.

Results:

A total of 1886 patients underwent hip surgery (hip arthroplasty = 691, fracture repair = 1195) between 1988 and 2002 and were followed for a year after hip surgery for stroke. The incidence rate of stroke 1 year after hip surgery was 25/1000 person (95% CI, 18‐32 per 1000 persons). In the univariate analysis hypertension and coronary artery disease were not statistically significant predictors of stroke, but atrial fibrillation (P = .01), urgency of surgery (P = .0012), age (P = .002), and history of previous stroke (P < .0001) were. In the multivariate analysis, history of stroke (P < .001; HR = 4.754) and age (P = .21; HR = 1.045) were confirmed to be strong predictors of postoperative stroke, but atrial fibrillation and urgency of surgery did not add significantly to the model.

Conclusions:

In this population‐based retrospective cohort study, history of stroke and age were found to be strong predictors of stroke after hip surgery, but atrial fibrillation and urgency of surgery, sex, hypertension, and coronary artery disease were not correlated with a higher incidence of postoperative stroke.

Author Disclosure:

A. Popa, none.