Abstract 15357: The Relationship Between Inpatient Hospitalization for Joint Surgery and Acute Decompensated Heart Failure

IntroductionNon-cardiac surgery in patients with heart failure (HF) is associated with increased mortality and readmissions. Orthopedic surgery is associated with large volume shifts and could be associated with HF exacerbation. Our aim is to examine the incidence of acute HF in hospitalized patients undergoing common large joint orthopedic surgery.MethodsWe conducted a retrospective cohort study of Medicare patients between 2005 - 2014. Patients were identified using the International Classification of Disease, ninth revision (ICD-9) procedure codes and included those who underwent either a primary total knee arthroplasty (TKA), total hip arthroplasty (THA), total shoulder arthroplasty (TSA), or lumbar fusion (LF). We calculated the incidence rate per 1000 person years of HF exacerbation, adjusted for cardiovascular comorbidities.ResultsA total of 4,356,825 patients underwent orthopedic surgery between 2005-2014. The majority of patients underwent a TKA (2,378,609) followed by THA (1,143,523), LF (687,775) and TSA (146,918). A total of 38,665 patients developed HF exacerbation 90 days after their orthopedic surgery (8.8 per 1000 person-years; 95% CI 8.1-9.0). Patients who underwent LF had the highest risk of developing HF exacerbation (100.4 per 1000 person-years; 95% CI 102-107) compared to patients who underwent TSA (6.0 per 1000 person-years; 95% CI 5.4-6.3). (figure 1)ConclusionsPatients who undergo orthopedic surgery are at risk of developing HF. This risk is highest for those patients undergoing spinal surgery.