Patients Who Have Pre-Existing Atrial Fibrillation Require Increased Postoperative Care Following Total Joint Arthroplasty

Background: Approximately 9% of total joint arthroplasty (TJA) patients have pre-existing atrial fibrillation (AF). This study examined the effect of pre-existing AF on TJA outcomes. Methods: We conducted a 1:3 propensity match of 545 TJA patients who have pre-existing AF to TJA patients who do not have AF at a tertiary care center between January 1st, 2012, and January 1st, 2021. Bivariate and multivariate regressions were performed. Changes over time were evaluated. Results: Patients undergoing total knee arthroplasty (TKA) who have pre-existing AF, experienced more post-operative AFs (P <.001), acute kidney injuries (P =.026), post-operative complications (POC) (P <.001), and 30-day readmissions (P =.036). Patients undergoing total hip arthroplasty (THA) who have pre-existing AF experienced more post-operative AFs (P <.001), pulmonary embolisms (P <.001), increased estimated blood losses (P =.007), more blood transfusions (P =.002), more POCs (P <.001), and longer lengths of stay (LOS) (P <.002). Over time, POC and LOS decreased in both groups, but remained increased in TJA patients who have pre-existing AF. Multivariate analyses of TKA patients showed an increased odds ratio (OR) of any POCs (P <.001), while THA patients had an increased OR of any POCs (P =.01), and LOS (P =.002). Conclusion: Patients who have pre-existing AF undergoing TJA have more POCs. TKA patients have more readmissions. THA patients have longer LOS. These findings demonstrate the importance of enhanced peri-operative medical management in patients who have pre-existing AF undergoing TJA.