Pre-Existing Atrial Fibrillation

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Patients with Pre-Existing Atrial Fibrillation and Postoperative Care after Total Joint Arthroplasty

Atrial fibrillation (AF) is a common cardiac arrhythmia that can lead to significant complications if not managed appropriately. Approximately 9% of patients undergoing total joint arthroplasty (TJA) have pre-existing AF. This article delves into the implications of pre-existing AF on postoperative outcomes in these patients.

A comprehensive study was conducted, examining the effect of pre-existing AF on TJA outcomes. The research included a 1:3 propensity match of 545 TJA patients with pre-existing AF to those without AF at a tertiary care center between January 1st, 2012, and January 1st, 2021. Both bivariate and multivariate regressions were employed to analyze the data.

  • Patients undergoing total knee arthroplasty (TKA) with pre-existing AF experienced more post-operative AFs, acute kidney injuries, post-operative complications (POC), and 30-day readmissions.
  • Those undergoing total hip arthroplasty (THA) with pre-existing AF faced more post-operative AFs, pulmonary embolisms, increased estimated blood losses, more blood transfusions, more POCs, and longer lengths of stay (LOS).
  • Over time, while POC and LOS decreased in both groups, they remained higher in TJA patients with pre-existing AF.
  • Multivariate analyses revealed an increased odds ratio (OR) of any POCs for TKA patients. In contrast, THA patients had an increased OR of any POCs and LOS.

Conclusion:
Patients with pre-existing AF undergoing TJA have more POCs. TKA patients have more readmissions, while THA patients have a longer LOS. These findings underscore the importance of enhanced perioperative medical management in TJA patients with pre-existing AF.

FAQs:

  1. Can a person with AFIB have knee replacement surgery?
    Yes, but they may require specialized postoperative care and monitoring due to the increased risk of complications.
  2. How do you treat postoperative atrial fibrillation?
    Treatment typically involves medications to control the heart rate and rhythm, and in some cases, electrical cardioversion.
  3. Can I have a hip replacement if I have atrial fibrillation?
    Yes, but similar to knee replacement, patients with AF may need enhanced postoperative care.
  4. Is it safe to have surgery with atrial fibrillation?
    While surgery can be performed on patients with AF, it’s crucial to manage the condition appropriately to minimize postoperative complications.

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