Preexisting atrial fibrillation may be associated with increased complications after TJA
Click Here to Manage Email Alerts
Key takeaways:
- Preexisting atrial fibrillation was associated with increased risk of complications after THA and TKA.
- These patients may require preoperative optimization and enhanced perioperative management.
Patients with preexisting atrial fibrillation are at increased risk for complications after total hip and knee arthroplasty and may require preoperative optimization and enhanced perioperative management, according to published results.
Researchers performed a propensity-matched cohort study of 225 patients with preexisting atrial fibrillation (AF) who underwent TKA and 320 patients with preexisting AF who underwent THA. Researchers compared postoperative outcomes with matched cohorts of 536 TKAs and 814 THAs performed in patients who did not have preexisting AF.
Among the TKA cohorts, patients with preexisting AF had increased risk for postoperative AF, acute kidney injuries and 30-day readmission compared with patients without preexisting AF. Among the THA cohorts, patients with preexisting AF had increased risk for
postoperative AF, pulmonary embolism, increased blood loss, increased blood transfusions and longer length of stay (LOS) compared with patients without preexisting AF.
Researchers noted overall rates of postoperative complications and LOS remained elevated for patients with preexisting AF over time.
“Our findings suggest that patients who have preexisting AF are at a higher risk of requiring postoperative care,” the researchers wrote in the study. “Therefore, thorough preoperative medical evaluation and optimization and enhanced perioperative management should be implemented as patients who have preexisting AF present for [total joint arthroplasty] TJA,” they concluded.
Perspective
Back to Top
This is a great update to the literature regarding patients with atrial fibrillation (AF) undergoing TJA. We already knew from previous studies that these patients present a challenging burden to postoperative care. However, taking into account the updated cardiac guidelines and the increasing prevalence of AF in patients undergoing TJA, the current study highlights an increased complication profile, length of stay and risk of readmission in this patient population. It is nonetheless encouraging that the authors found, over time, we are getting better at taking care of these patients, whether that is because of increased use of tranexamic acid, decreased use of warfarin or even other factors.
With bundle payments and hospital rankings hinging on complication-free outcomes after joint replacement, this study emphasizes the need to accurately and comprehensively document all patient comorbidities such as AF in the chart prior to operating. This will hopefully allow for a more fitting assessment of hospital reimbursements without penalizing institutions that take on higher-risk patients for TJA.
Collapse
Click Here to Manage Email Alerts