Abstract
Introduction
The study objective was to ascertain the incidence of bleeding and ischemic complications related to acute and planned orthopedic surgery in patients with known cardiovascular diseases.
Materials and methods
The study conducted between 2010 and 2013 enrolled 477 patients (289 women, 188 men) with a diagnosed cardiovascular disease or a history of thromboembolic event. Aside from gender, age, height and weight, the study observed other anamnestic data and perioperative laboratory test results that may impact on a bleeding or ischemic event.
Results
Two hundred seventy-two (57 %) patients had acute surgery, and 205 (43 %) patients had elective surgery. Complications arose in 55 (11.6 %) patients, 32 (6.9 %) had bleeding complications, 19 (4.0 %) ischemic complications, and both complications were experienced by 4 (0.8 %) patients. Bleeding developed in 14 (5.1 %) patients who had acute surgery, and in 22 (10.7 %) who had elective surgery. Twenty-two (8.1 %) patients having acute surgery and one (0.1 %) undergoing elective surgery suffered from ischemic complications. The incidence of bleeding complications was significantly higher in elective surgery (p = 0.026, OR 2.22), and when adjusted (general anaesthesia, gender, and use of warfarin), the difference was even higher (p = 0.015, OR 2.44), whereas the occurrence of ischemic complications was significantly higher in acute surgery (p = 0.005, OR 18.0), and when adjusted (age), the difference remained significant (p = 0.044, OR 8.3).
Conclusions
The study noted a significantly higher incidence of bleeding complications in elective orthopedic surgery when compared with acute surgery. Conversely, the incidence of ischemic complications was significantly higher in patients having acute orthopedic surgery when compared with those operated on electively.
Similar content being viewed by others
References
Decker RC, Foley JR, Moore TJ (2010) Perioperative management of the patient with cardiac disease. J Am Acad Orthop Surg 18(5):267–277
Kadono Z, Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S, Tanaka S, Nakamura K (2010) Statistics for orthopedic surgery 2006–2007: data from the Japanese Diagnosis Procedure Combination database. J Orthop Science 15(2):162–170
Neuhaus V, Bot AG, Swellengrebel CH, Jain NB, Warner JJ, Ring DC (2014) Treatment choise affects inpatient adverse events and mortality in older aged inpatients with an isolated fracture of the proximal humerus. J Shoulder Elbow Surg 23(6):800–806
Lee HL, Chiu KY, Yiu KH, Ng FY, Yan CH, Chan PK (2013) Perioperative antithrombotic management in joint replacement surgeries. Hong Kong Med J 19(6):531–538
Sanders RD, Bottle A, Jameson SS, Mozid A, Aylin P, Edger L, Ma DQ, Reed MR, Walters M, Lees KR, Maze M (2012) Independent preoperative predictors of outcomes in orthopedic and vascular surgery the influence of time interval between an acute coronary syndrome or stroke and the operation. Ann Surg 255(5):901–907
Bushnell BD, Horton JK, McDonald MF, Robertson PG (2008) Perioperative medical comorbidities in the orthopaedic patient. J Am Acad Orthop Surg 16(4):216–227
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R (2012) Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl S):E326S–E350S
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen, Colwell CW, Ray JG (2004) Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126(3 Suppl S):338S–400S
Oberweis BS, Nukala S, Rosenberg A, Guo Y, Stuchin S, Radford MJ, Berger JS (2013) Thrombotic and bleeding complications after orthopedic surgery. Am Hearth J 165(3):427–433
Vetter TR, Boudreaux AM, Papapietro SE, Smith PW, Taylor BB, Porterfield JR Jr (2012) The perioperative management of patients with coronary artery stents: surveying the clinical stakeholders and arriving at a consensus regarding optimal care. Am J Surg 204(4):453–461
Biondi-Zoccai G, Lotrionte M, Agostoni P, Abbate A, Fusaro M, Burzotta F, Testa L, Sheiban I, Sangiorgi G (2006) A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease. Eur Heart J 27(22):2667–2674
Korte W, Cattaneo M, Chassot PG, Eichonger S, von Heymann C, Hofmann N, Rickli H, Spannagl M, Ziegler B, Verheugt F, Huber K (2011) Peri-operative management of antiplatelet therapy in patients with coronary artery disease. Thromb Haemost 105(5):743–749
Widimsky P, Motovska Z, Havluj L, Ondrakova M, Bartoska R, Bittner L, Dusek L, Dzupa V, Knot J, Krbec M, Mencl L, Pachl J, Grill R, Haninec P, Waldauf P, Gurlich R (2014) Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The Prague-14 registry. Neth Heart J 22(9):372–379
Chrastina J, Hrabovsky D, Zvarova M, Riha I, Novak Z (2014) The effect of anticoagulation and anti-agregation treatment on the extent, development ant prognosis of acute craniocerebral injury. Acta Chir Orthop Traumatol Cech 81(1):77–84 (in Czech)
Cluett J, Caplan J, Yu W (2008) Preoperative cardiac evaluation of patients with acute hip fracture. Am J Orthop 37(1):32–36
Motovska Z (2011) Management of antiplatelet therapy in patients at risk for coronary stent thrombosis undergoing non-cardiac surgery. Drugs 71(14):1797–1806
Acknowledgments
The study was supported by a research grant of the Czech Ministry of Health IGA No. NT 11506-6/2010. The authors thank to Olga Dzupova for the help with manuscript correction.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None declared by any of the authors.
Rights and permissions
About this article
Cite this article
Džupa, V., Waldauf, P., Moťovská, Z. et al. Risk comparison of bleeding and ischemic perioperative complications after acute and elective orthopedic surgery in patients with cardiovascular disease. Arch Orthop Trauma Surg 136, 907–911 (2016). https://doi.org/10.1007/s00402-016-2468-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-016-2468-y