Perioperative acute myocardial infarction rate in chronic renal disease patients undergoing orthopedic surgery: Is there any difference between dialyzed and nondialyzed patients?

Abstract

Background The incidence of acute myocardial infarction (AMI) in healthy patients undergoing noncardiac surgery is <1%. When patients with chronic kidney disease (CKD) undergo orthopedic surgery, AMI incidence can be expected to be relatively high. However, data on a population-wide scale is lacking. Objective To investigate AMI incidence in patients with CKD (with and without dialysis) undergoing orthopedic surgery. Design A population-based study covering the period from January 1, 1997, to December 31, 2011. Setting Data from the Taiwan National Health Insurance Research Database. Participants Participants were 219,195 patients with CKD who underwent surgery between January 1, 1997, and December 31, 2011. Results AMI occurred in 2,708 participants (1.24%). The AMI incidence rate in the dialyzed group was 1.52%, which was higher than that in the nondialyzed group after propensity score matching. Dialysis (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.62–1.98), male (OR: 1.42; 95% CI: 1.28–1.57), diabetes mellitus (OR: 1.61; 95% CI: 1.44–1.80), hyperlipidemia (OR: 1.88; 95% CI: 1.68–2.11), old myocardial infarction (OR: 18.87; 95% CI: 16.26–1.21.90), and cerebral vascular disease (CVA) (OR: 1.29; 95% CI: 1.30–1.47) were all associated with AMI in the patients with CKD. Conclusions The AMI risk was higher in the patients with CKD undergoing orthopedic surgery than in the general population, and the dialyzed group had a higher risk of AMI than did the nondialyzed group.