July 23, 2012 — The medical journal Archives of Internal Medicine has published a study finding that people aged 60 or older are significantly more likely to have a heart attack shortly after undergoing hip or knee replacement surgery. People under 60 have no increased risk, and people over 80 have a significantly increased risk. The risk is highest in the first two weeks, and persists for the next six weeks. Increased stress may be a risk factor. The researchers warned that patients who had a heart attack in the last 12 months should not undergo elective hip replacement surgery.
The researchers collected and analyzed the hospital records on nearly 100,000 people who had a knee or hip replacement surgery between 1998 – 2007. Each person was compared to three people with similar demographics (age, gender) who did not have a knee or hip replacement surgery.
The researchers found the following risk of heart attack:
- Hip replacement patients: One in 200 had a heart attack. This is a 25-fold increased risk of heart attack
- Knee replacement patients: One in 500 had a heart attack. This is a 31-fold increased risk of heart attack.
It is not clear why surgery patients have an increased risk of heart attacks. Many factors could contribute, including the surgery itself. Doctors already know that surgery patients have a higher risk of blood clots, which could travel to the heart and cause a heart attack. The clots form in the marrow of bones involved in surgery. To reduce this risk, patients are given powerful anti-clotting medications (such as warfarin). However, even with the medication, patients were more likely to have a heart attack for six weeks after surgery.
Stress may also play a role. Stress is a known risk factor for heart attacks, and patient stress levels are often very high before surgery and after surgery.
Other factors could have also influenced the results. The researchers did not control for obesity. Overweight people are more likely to undergo hip or knee replacement surgery, and they are also more likely to have a heart attack. High blood pressure or smoking could also contribute to the increased risk.
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