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Predictors of ischemic stroke after hip operation: A population‐based study
Author(s) -
Popa Alina S.,
Rabinstein Alejandro A.,
Huddleston Paul M.,
Larson Dirk R.,
Gullerud Rachel E.,
Huddleston Jeanne M.
Publication year - 2009
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.531
Subject(s) - medicine , stroke (engine) , hip fracture , atrial fibrillation , hazard ratio , population , univariate analysis , cohort , surgery , aspirin , incidence (geometry) , multivariate analysis , osteoporosis , confidence interval , mechanical engineering , environmental health , engineering , physics , optics
BACKGROUND: Hip operation (total hip arthroplasty [THA] or fracture repair) is the most common noncardiac surgical procedure performed in patients age 65 years and older. OBJECTIVE: To determine the predictors of ischemic stroke in patients who have undergone hip operation. DESIGN: Population‐based historical cohort study, in which postoperative ischemic strokes were identified from medical record review for stroke diagnostic codes and brain imaging results and were confirmed by physician review. SETTING: Tertiary care center in Olmsted County, Minnesota. PATIENTS: Residents of Olmsted County who underwent hip surgical procedure. MEASUREMENTS: Incidence of ischemic stroke within 1 year of hip operation. RESULTS: In total, 1606 patients underwent 1886 hip procedures from 1988 through 2002 and were observed for ischemic stroke for 1 year after their procedure. Sixty‐seven ischemic strokes were identified. The rate of stroke at 1 year after hip operation was 3.9%. In univariate analysis, history of atrial fibrillation (hazard ratio [HR], 2.16; P = 0.005), hip fracture repair vs. total hip arthroplasty (HR, 3.80; P < 0.001), age 75 years or older (HR, 2.20; P = 0.02), aspirin use (HR, 1.8; P = 0.01), and history of previous stroke (HR, 4.18; P < 0.001) were significantly associated with increased risk of stroke. In multivariable analysis, history of stroke (HR, 3.27; P < 0.001) and hip fracture repair (HR, 2.74; P = 0.004) were strong predictors of postoperative stroke. CONCLUSIONS: This population‐based historical cohort of patients with hip operation had a 3.9% cumulative probability of ischemic stroke over the first postoperative year. Hip fracture repair and history of stroke were the strongest predictors of this complication. Journal of Hospital Medicine 2009;4:298–303. © 2009 Society of Hospital Medicine.