Perioperative Atrial Fibrillation Predicts 1 Year Mortality after Knee and Hip Replacement

Introduction: Hip and knee arthroplasty are common in elderly patients with more medical comorbidities. These patients are more likely to suffer from atrial fibrillation (AF) or to develop AF after an operation. Previous studies have shown that perioperative atrial fibrillation has a significant influence on mortality in patients with hip fractures. We conducted this study to see if this effect appears in elective arthroplasties as well.

Methods: We reviewed the files of 280 consecutive patients of age 60 or more, who had undergone total knee or hip arthroplasty with AF along with 280 files of control patients without AF matched for age, gender and operation type (hip/knee). Several known risk factors for AF and 1 year mortality were also recorded.

Results: Of the 280 patients with peri-operative AF, 37 had new onset AF with a 1-year mortality rate of 10.8%. This mortality was significantly higher in patients with new-onset AF compared to patients without AF or patients with previous AF (10.8%, vs. 1.1% and 2.5%, respectively; p=0.005). On multivariate analysis, this difference remained significant after adjustment for risk factors associated with mortality.

Conclusion: One-year mortality in elderly patients undergoing TKA or THA is significantly increased in patients with new postoperative AF. These patients warrant increased clinical surveillance following surgery.