Association of perioperative use of nonsteroidal anti-inflammatory drugs with postoperative myocardial infarction after total joint replacement

Abstract

Background and objectives: Use of nonsteroidal anti-inflammatory drug (NSAIDs) analgesics is controversial because of cardiovascular risk, but perioperative use may be advantageous for total joint replacement. Thus, we performed this single-center observational cohort study to determine any association between NSAID use and postoperative myocardial infarction (POMI).

Methods: All patient admissions undergoing total hip or knee replacement between March 3, 2009, and September 1, 2010, were identified. Nonsteroidal anti-inflammatory drug use was identified. Postoperative myocardial infarction was defined as troponin I level greater than 0.1 ng/mL. Propensity scores were calculated to adjust for bias of receiving NSAIDs and troponin measurements. Propensity scores and other covariates were used in logistic regression to determine the independent association of NSAID use with POMI.

Results: Of the 10,873 arthroplasty admissions, 1518 (14%) had serial troponins measured, and 97 had a POMI (0.9%). Incidence of POMI was 0.8% for the 9,831 who received NSAIDs and 1.8% for the 1,042 (10%) admitted patients who did not receive NSAIDs with a risk difference of -1% with 95% confidence interval (CI) of -0.2% to -1.9%. The adjusted odds ratio (0.95; 95% CI, 0.5-1.8) and relative risk (0.95; 95% CI, 0.5-1.8) indicated that NSAIDs were not significantly associated with the risk of POMI. Mean duration of NSAID use was 3 days. Length of stay (98 versus 115 hours) was significantly reduced in the NSAID group.

Conclusions: Brief perioperative use of NSAIDs was not associated with increased risk for myocardial infarction after total hip and knee replacement; it may provide benefit in length of stay.