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Ann Surg. 2012 May;255(5):901-7. doi: 10.1097/SLA.0b013e31824c438d.

Independent preoperative predictors of outcomes in orthopedic and vascular surgery: the influence of time interval between an acute coronary syndrome or stroke and the operation.

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Magill Department of Anaesthetics, Intensive Care and Pain Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK.



To identify independent preoperative predictors of outcome for total hip or knee replacement (THKR) and abdominal aortic aneurysm (AAA) repair, including the importance of the time interval between an acute coronary syndrome (ACS) or stroke and surgery.


Present guidelines do not advocate a prolonged delay after ACS though recent data suggest delaying operations by 8 weeks. There is a lack of data on when to schedule surgery following stroke.


The Hospital Episode Statistics database was analyzed for elective admissions for THKR and AAA surgery between 2006-2007 and 2009-2010. Patient factors influencing mortality, length of stay, and readmission rates were identified by logistic regression.


A total of 414,985 THKRs (mortality: 0.2%) and 14,524 AAA repairs (mortality: 3.5%) were included. Heart failure, renal failure, liver disease, peripheral vascular disease, and non-atrial fibrillation arrhythmia increased the odds of mortality for both surgeries. Among other factors, previous ACS and stroke predicted mortality after THKR but not AAA surgery. Compared with more delayed surgery, THKR surgery performed within 6 months of an ACS (odds ratio [OR]: 3.81; 95% confidence interval [CI]: 1.55-9.34), but not stroke, increased the odds of mortality. The effect of ACS persisted up to 12 months (OR: 1.99; 95% CI: 1.02-3.88) and was not altered by exclusion of patients who received percutaneous coronary intervention or coronary artery bypass grafting for treatment of their ACS.


Previous stroke and ACS increased the odds of perioperative mortality from THKR but not AAA surgery; THKR surgery conducted up to 12 months after an ACS was associated with increased mortality.

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