Predictors of ischemic stroke after hip operation: A population-based study

Alina S. Popa, Alejandro A. Rabinstein, Paul M. Huddleston, Dirk R. Larson, Rachel E. Gullerud, Jeanne M. Huddleston

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background: Hip operation (total hip arthroplasty [THA] or fracture repair) is the most common noncardiac surgical procedure performed in patients age 65 years and older. Objective: To determine the predictors of ischemic stroke in patients who have undergone hip operation. Design: Population-based historical cohort study, in which postoperative ischemic strokes were identified from medical record review for stroke diagnostic codes and brain imaging results and were confirmed by physician review. Setting: Tertiary care center in Olmsted County, Minnesota. Patients: Residents of Olmsted County who underwent hip surgical procedure. Measurements: Incidence of ischemic stroke within 1 year of hip operation. Results: In total, 1606 patients underwent 1886 hip procedures from 1988 through 2002 and were observed for ischemic stroke for 1 year after their procedure. Sixty-seven ischemic strokes were identified. The rate of stroke at 1 year after hip operation was 3.9%. In univariate analysis, history of atrial fibrillation (hazard ratio [HR], 2.16; P = 0.005), hip fracture repair vs. total hip arthroplasty (HR, 3.80; P < 0.001), age 75 years or older (HR, 2.20; P = 0.02), aspirin use (HR, 1.8; P = 0.01), and history of previous stroke (HR, 4.18; P < 0.001) were significantly associated with increased risk of stroke. In multivariable analysis, history of stroke (HR, 3.27; P < 0.001) and hip fracture repair (HR, 2.74; P = 0.004) were strong predictors of postoperative stroke. Conclusions: This population-based historical cohort of patients with hip operation had a 3.9% cumulative probability of ischemic stroke over the first postoperative year. Hip fracture repair and history of stroke were the strongest predictors of this complication.

Original languageEnglish (US)
Pages (from-to)298-303
Number of pages6
JournalJournal of hospital medicine
Issue number5
StatePublished - 2009


  • Arthroplasty
  • Hip
  • Hip fracture
  • Ischemia
  • Stroke

ASJC Scopus subject areas

  • Internal Medicine
  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis


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