PB1471 - Age- and sex specific risks of major cardiovascular complications and death following elective hip and knee arthroplasty in the Netherlands: a Dutch Hospital Data Registry study

Background: Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are associated with serious (cardiovascular) complications, including venous thromboembolism (VTE), arterial thromboembolism (ATE), major bleeding and death. Although essential to adequately inform patients, stratified absolute risk estimates for these complications are lacking. In the Netherlands, 4-6 weeks thromboprophylaxis is given post THA and TKA.

Aims: We aimed to 1) estimate overall risks, 2) assess possible time trends and 3) estimate age- and sex specific risks in the Netherlands over recent years.

Methods: Data on procedures and diagnoses were obtained from the Dutch Hospital Data registry. All patients with a first primary THA or TKA for osteo-arthritis, conducted in all Dutch hospitals between 2015 and 2020, were included. Outcomes of interest were VTE, ATE, major bleeding and death at 30- and 90-days following surgery. All analysis were stratified for procedure type. For aim 1, the overall risks over 2015 until 2020 were estimated. For aim 2, the risks over the inclusion years were plotted separately. Lastly, risks were estimated after stratification for sex and age. Death was taken into account as competing risk for all analyses.

Results: 110,470 patients with a THA and 117,526 patients with TKA were included. The mean age was 69.9 years and 64% was female. Aim 1: overall risk of VTE, ATE, bleeding and death are reported in table 1. Aim 2: the risks for any of the adverse outcomes remained stable over the years. Aim 3: across outcomes and for all cardiovascular complications combined (figure 1), the risks were higher in men and increased with age. Only for THA, a higher risk of VTE was observed in women.

Conclusion(s): Absolute risks of cardiovascular complications and death following THA/TKA have been stable over recent years. Stratification for subgroups will enable orthopedic surgeons to better inform their patients.