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Patients with Atrial Fibrillation Undergoing Total Joint Arthroplasty Increase Hospital Burden
Vinay K. Aggarwal, BA1; Eric H. Tischler, BA1; Zachary D. Post, MD1; Ian Kane, BS1; Fabio R. Orozco, MD1; Alvin Ong, MD1
1 The Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 2nd Floor, Philadelphia, PA 19107. E-mail address for V.K. Aggarwal: vinayagg1@gmail.com. E-mail address for A. Ong: Alvin.Ong@rothmaninstitute.com
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Investigation performed at The Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Sep 04;95(17):1606-1611. doi: 10.2106/JBJS.L.00882
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Abstract

Background: 

More than 3 million people in the United States have atrial fibrillation, most of whom are being managed with anticoagulation therapy for life. The goal of the present study was to examine the effect of chronic anticoagulation therapy on patients with atrial fibrillation who undergo total joint arthroplasty.

Methods: 

We retrospectively reviewed all patients undergoing aseptic primary or revision total joint arthroplasty at our facility from March 2007 to August 2011. One hundred and sixty-one patients with atrial fibrillation (Group A) were compared with 161 matched controls (Group B). A total of 112 hips and 210 knees underwent 239 primary arthroplasties and eighty-three revisions. The groups were compared with use of conditional logistic regression (with matching on the basis of the involved joint [hip or knee], type of procedure [revision or primary], age, and sex) with regard to the length of hospital stay, postoperative hemoglobin levels, transfusion requirements, and readmissions.

Results: 

The preoperative length of stay (1.7 versus 0.2 days; p < 0.0001), postoperative length of stay (4.6 versus 3.2 days; p = 0.0002), and total length of stay (6.3 versus 3.4 days; p < 0.0001) were significantly longer for patients with atrial fibrillation (Group A). Hemoglobin levels were lower (but not significantly so) for Group A at baseline (13.1 versus 13.8 mg/dL), on Postoperative Day 2 (10.1 versus 10.6 mg/dL), on Postoperative Day 3 (9.8 versus 10.2 mg/dL), on Postoperative Day 4 (9.6 versus 10.1 mg/dL), on Postoperative Day 5 (9.7 versus 9.9 mg/dL), and at discharge (9.9 versus 10.3 mg/dL). Group A had a significantly higher prevalence of blood transfusion (15.5% versus 3.7%; p = 0.0005) and periprosthetic joint infection (5.6% versus 0.62%; p = 0.0196). A diagnosis of atrial fibrillation (odds ratio, 4.09; 95% confidence interval, 2.05 to 8.18; p < 0.0001) significantly increased the odds of total joint arthroplasty complication and the need for hospital readmission.

Conclusions: 

Patients with preoperative atrial fibrillation undergoing total joint arthroplasty had an increased length of hospital stay, increased transfusion requirements, and an increased risk of periprosthetic joint infection and unplanned hospital readmission.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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