Chronic Corticosteroid Use as a Risk Factor for Perioperative Complications in Patients Undergoing Total Joint Arthroplasty

Background: Postoperative delirium (POD), a neurobehavioral syndrome induced by dysfunction of neural activity, is a common and serious complication. This current study aimed to investigate independent predictors for POD in elderly subjects after total joint arthroplasty (TJA). Methods: Eligible elderly patients (≥65 years) who underwent elective unilateral primary hip or knee arthroplasty under epidural anesthesia from October 2016 to January 2019 were consecutively enrolled. POD was diagnosed following the guidance of the 5th edition of Diagnostic and Statistical Manual of Mental Disorders, (DSM V, 2013). The relative change in serum Alb (ΔAlb) was defined as the absolute value of (preoperative Alb value– nadir value within postoperative day 2)/preoperative Alb ×100%. The predictive value of ΔAlb for POD was evaluated by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate logistic regression analyses were used for evaluating risk factors for POD. Results: A total of 328 patients were enrolled in the analysis, of which 68 (20.7%, 68/328) patients developed POD within postoperative 7 days. ΔAlb was an effective predictor for POD with an area under the curve (AUC) of 0.821, a sensitivity of 76.15% and a specificity of 70.59%, respectively (P<0.001). Univariate and multivariate logistic regression analyses indicated that ΔAlb was the only independent risk factor for POD (OR: 2.43, 95%CI: 1.17–4.86, P=0.015). Conclusions: ΔAlb was an independent risk factor for POD in elderly subjects after TJA.

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Dysregulation of Tissue Factor, Thrombin-Activatable Fibrinolysis Inhibitor, and Fibrinogen in Patients Undergoing Total Joint Arthroplasty

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029617700998 ◽

2017 ◽

Vol 23 (8) ◽

pp. 967-972 ◽

Cited By ~ 5

Author(s):

Christopher Wanderling ◽

Jeffrey Liles ◽

Elissa Finkler ◽

Peter Carlsgaard ◽

William Hopkinson ◽

...

Keyword(s):

Tissue Factor ◽

Total Joint Arthroplasty ◽

Surgical Intervention ◽

Perioperative Complications ◽

Joint Arthroplasty ◽

Enzyme Linked Immunosorbent Assay ◽

Activity Assay ◽

Thrombin Activatable Fibrinolysis Inhibitor ◽

Common Procedure ◽

Fibrinolysis Inhibitor

Total joint arthroplasty (TJA) of the hip or knee (THA, TKA) has become an increasingly common procedure. While TJA is a successful treatment for individuals experiencing degenerative joint diseases, it is well known that one of the most common perioperative complications of TJA is deep venous thrombosis (DVT). To profile tissue factor (TF), microparticle-tissue factor (MP-TF), thrombin-activatable fibrinolysis inhibitor (TAFI), and fibrinogen levels in patients undergoing TJA to determine potential preexisting Hemostatic dysregulation. De-identified blood samples were obtained from patients undergoing TJA 1 day pre- and 1 day postprocedure. Plasma samples were analyzed using enzyme-linked immunosorbent assay kits for fibrinogen, TAFI, TF, and MP-TF; fibrinogen levels were also assessed using a clot-based activity assay. In comparison with healthy controls, there were significant increases of fibrinogen and MP-TF levels, while there were significant decreases in TF and TAFI levels in the preoperative and postoperative patients. Comparing the pre versus postoperative patients, no significant differences were found; interestingly, however, surgical intervention exacerbated the changes found in the preoperative samples compared to the controls. The results of this study confirm that patients undergoing TJA have preexisting alterations in the fibrinolytic system. Surgical intervention tended to exacerbate these changes. The alterations observed in this study may provide insight as to why TJA is associated with higher rates of DVT and thromboembolism.

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