Joint Replacement Boosts Heart Attack Risk Right After Surgery: Study

HealthDay – 1 hr 40 mins ago MONDAY, July 23 (HealthDay News) -- People who have total hip or knee replacement surgery are about 30 times more likely to have a heart attack in the two weeks after the procedure, a new study finds.

Both surgeries are common treatments for arthritic hips and knees, with almost 2 million done around the world each year, the researchers noted.

"This study confirms the increased cardiac risk in the period following total hip and knee replacement," said lead researcher Dr. Arief Lalmohamed, from Utrecht University in the Netherlands. "Risk assessment and preoperative use of cardiovascular drugs may be necessary to reduce the risk of heart attack."

The effects of the operation are likely responsible for the increased risk of heart attack, Lalmohamed added. While the study showed an association between the two events, it did not prove a cause-and-effect relationship.

These side effects of surgery include the aftereffects of anesthesia on the cardiovascular system, blood loss, arrhythmias (irregular heartbeat) and lack of oxygen, all of which are known to increase risk of heart attacks, he said.

"In addition, the period before surgery itself is a very stressful time for the patient, even thinking about surgery increases cardiac risk," Lalmohamed said.

The report was published online July 23 in the Archives of Internal Medicine.

For the study, Lalmohamed's team used Danish registries to estimate the risk of heart attack after these operations.

In total, the researchers had data on more than 95,000 patients who underwent total hip or knee replacement surgery between January 1998 and December 2007.

The investigators compared the heart attack risk in these patients to more than 286,000 similar patients who didn't have surgery.

During the first two weeks after surgery, the risk for a heart attack was increased 25-fold for total hip replacement patients and 31-fold for total knee replacement patients, the study authors found.

The risk decreased rapidly after that, the researchers noted.

Six weeks after surgery, the absolute risk of a heart attack had dropped to 0.51 percent in patients who had a total hip replacement and 0.21 percent for those who had a total knee replacement, the investigators found.

The risk of having a heart attack was highest in those aged 60 and older, particularly patients aged 80 and older, and those who had experienced a heart attack in the six months before surgery. The latter increased the risk fourfold in the six weeks after the procedure, the authors noted.

"There is cardiac risk when a patient has a major operation," said Dr. Arthur Wallace, chief of the Anesthesia Service Veterans Affairs Medical Center in San Francisco.

"Anesthesiologists, surgeons and hospitalists need to use preoperative cardiac risk reduction to reduce that risk," added Wallace, who wrote an accompanying journal editorial.

Dr. Gregg Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, said that "total hip replacement and total knee replacement are commonly performed surgeries, yet the risk of heart attacks occurring during or in the weeks following surgery have not been well-defined compared to the general population."

This new study shows the risk of a heart attack after these surgeries is small in absolute terms (one in 200 to one in 500 patients), he said.

"This increased heart attack risk may be lessened by careful preoperative cardiovascular risk assessment, continuation of aspirin, use of statin medications and careful monitoring in the first two to six weeks after orthopedic surgery," Fonarow said.

More information

For more information on joint replacement, visit the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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Diabetes Can Make a Comeback After Weight-Loss Surgery: Study

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Some May Drink More After Weight-Loss Surgery: Study

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- The risk of alcohol problems goes up somewhat in patients who have undergone weight-loss surgery, but not until more than a year after undergoing the procedure, new research finds.

The study doesn't prove that the procedures directly boost the risk of alcohol problems, and it's not clear why the likelihood goes up in the second year after surgery instead of the first. However, previous research suggests that weight-loss surgery may disrupt how the bodies of patients absorb alcohol, giving more of a punch to individual drinks.

One weight-loss surgery specialist questioned the value of the study. But lead author Wendy King, a University of Pittsburgh assistant professor of epidemiology, said the findings "really point to the need for discussions of the benefits and risks to include this."

Weight-loss surgery, also known as bariatric surgery, aims to treat severe obesity by physically limiting the amount of food that the body can process. Several types of bariatric procedures allow physicians to accomplish this by shrinking the size of the stomach.

King said there have been reports in the media about patients who became alcoholics after the surgery, but research is lacking. So King and colleagues followed 2,458 patients -- with an average age of 47 years, 79 percent were female and 87 percent were white -- before and after they underwent weight-loss surgeries. The patients had the procedures between 2006 and 2011.

A year after surgery, the percentage of patients who showed signs of alcohol problems stayed steady at about 7 percent. But two years after the surgery, almost 10 percent showed signs of alcohol problems.

Still, "it's certainly not a surgery that going to make everyone become an alcoholic," King said. "That's not the case."

Alcohol problems were more common in younger patients, males and those who smoked, drank at least a couple of drinks a week or used drugs. Those who underwent a procedure known as Roux-en-Y gastric bypass were also more likely to develop alcohol problems, confirming the results of a Swedish study presented at the Digestive Disease Week conference in 2011.

That procedure, which restricts food intake by creating a small pouch out of the stomach, allows alcohol to be absorbed more quickly by the body, King explained.

Why might weight-loss surgery lead to higher rates of alcohol problems? King said there are several theories. Perhaps, she said, patients become tired of strict rules about what they eat and drink. Or maybe they develop new social lives that include drinking after losing large amounts of weight.

Dr. Edward Phillips, chief of general surgery at Cedars-Sinai Medical Center in Los Angeles, pointed to another potential factor: Extremely obese people -- for example, a 450-pound man -- will lose some of their tolerance for alcohol consumption when they lose weight. "Some just don't realize that less alcohol produces as much or more of an effect," he said.

Despite the findings, weight-loss operations remain the best surgery for severely obese people, King said.

Dr. T. Karl Byrne, a professor of surgery and director of bariatric surgery at the Medical University of South Carolina, was unimpressed by the study, saying it's "not particularly useful."

"The rise in alcoholism after bariatric surgery doesn't seem that significant," he said. "Patients who are morbidly obese are addicted to food. If this addiction is altered or improved with bariatric surgery, there may be transfer of the addiction to alcohol, gambling, hypersexuality, spending and shopping, etc. It's not the surgery. It's the addictive personality."

Phillips, however, found the study useful and said it shows the importance of following up with patients over time, even years after a procedure. "Most patients don't come back if they are OK, or are embarrassed that they are regaining weight, or are using drugs or alcohol," he said.

The study was published online June 18 in the Journal of the American Medical Association.

While the study found an association between weight-loss surgery and increased drinking, it did not prove a cause-and-effect relationship.

More information

For more about weight-loss surgery, try the U.S. National Library of Medicine.

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Women Can Waive Test Before Incontinence Surgery: Study

HealthDay – 3 hrs ago WEDNESDAY, May 2 (HealthDay News) -- Many women are sent for pricey bladder-function tests before surgery for urinary incontinence. However, a new study suggests that in many cases these tests are not needed.

The tests are designed for patients with stress urinary incontinence -- a leakage of urine caused by muscle weakness in the pelvis and sphincter. But a team from the Urinary Incontinence Treatment Network found that women who had an office visit alone before their operation experienced results that were similar to women who also had these costly and invasive tests.

Bladder function tests assess how well the bladder, sphincter muscles and urethra store and release urine. The tests, however, averaging about $500 and uncomfortable for patients since many involve the insertion of a catheter or filling the bladder with fluid.

In conducting the study, researchers followed 630 women undergoing surgery for stress urinary incontinence. Half of the women had bladder testing and a checkup before their surgery. The others just had a pre-operative visit to their doctor.

The researchers report that the rate of treatment success -- about 77 percent -- was similar for the women regardless of whether or not they got the pre-op test. There was also no significant difference in the women's quality of life, satisfaction, or ability to empty their bladder completely.

The study, funded by the U.S. National Institutes of Health (NIH), was published online May 2 in the New England Journal of Medicine.

"The findings of our study argue against routine pre-operative testing in cases of uncomplicated stress urinary incontinence, as the tests provide no added benefit for surgical treatment success but are expensive, uncomfortable, and may result in complications such as urinary tract infections," the study's lead author, Dr. Charles Nager, director of urogynecology and reconstructive pelvic surgery at the University of California, San Diego, said in an NIH news release.

However, one expert believes the tests do have real value.

"Leaking of urine or urinary incontinence is a very common problem, affecting about 50 percent of women," said Dr. Peter Finamore, a urogynecologist at Winthrop University Hospital in Mineola, NY. "There are different reasons why women leak urine. The reason why we differentiate the types of urinary incontinence is because of how we treat this problem. Some leaking can be treated with physical therapy, some with medication and some with surgery."

These urodynamic screening methods are "a test on the nerve and muscle function of the bladder," Finamore explained. "It is an important test for patients with urinary incontinence that provides a great deal of valuable information that is essential to determine the appropriate treatment options. The test does have a financial cost, but for those of us who treat urinary incontinence that cost is worth it in order to make the appropriate diagnosis and treat patients properly."

Finamore added that, "the risk of complications such as urinary tract infection following urodynamics is very rare and we often give preventative antibiotics at the time of administering this test."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases provides more information on urinary incontinence in women.

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Turmeric extract may protect heart after surgery: study

Reuters – 9 hrs ago (Reuters) - Extracts from turmeric spice, known for their antioxidant and anti-inflammatory properties, may help ward off heart attacks in people who have had recent bypass surgery, according to a study from Thailand.

During bypass surgery the heart muscle can be damaged by prolonged lack of blood flow, increasing the patient's risk of heart attack. But the new findings, published in the peer-reviewed American Journal of Cardiology, suggest that curcumins - the yellow pigment in turmeric - may ease those risks when added to traditional drug treatment.

The conclusions are based on a relatively small group of subjects and needs to be confirmed in larger studies, said researchers led by Wanwarang Wongcharoen from Chiang Mai University. Turmeric extracts have long been used in traditional Chinese and Indian medicine.

Research has suggested inflammation plays an important role in the development of a range of diseases, including heart disease, and curcumins could have an effect on those pathways, said Bharat Aggarwal, who studies the use of curcumins in cancer therapy at the MD Anderson Cancer Center in Houston, Texas.

"It's very, very encouraging," said Aggarwal of the study, which he did not take part in.

The researchers studied 121 patients who had non-emergency bypass surgery at their hospital between 2009 and 2011.

Half of those patients were given one-gram curcumin capsules to take four times a day, starting three days before their surgery and continuing for five days afterwards. The other half took the same number of drug-free placebo capsules.

The researchers found that during their post-bypass hospital stays, 13 percent of patients who'd been taking curcumins had a heart attack, compared to 30 percent in the placebo group.

After accounting for any initial pre-surgery differences, Wongcharoen and his colleagues calculated that people on curcumins had a 65 percent lower chance of heart attack.

Researchers said it's likely that the antioxidant and anti-inflammatory properties of curcumins may have helped limit heart damage in the patients.

"Curcumin has for many years now been shown to reduce inflammation and to reduce oxygen toxicity or damage caused by free radicals in a number of experimental settings," said Jawahar Mehta, a cardiologist at the University of Arkansas for Medical Sciences in Little Rock, who didn't work on the study.

"But that doesn't mean that this is a substitute for medication," he said, noting that drugs like aspirin, statins and beta blockers have been proven to help heart patients and people in the current study were taking those as well.

One limitation was that the study was relatively small. Another is that while curcumins are thought to be safe, there could be side effects at very large doses.

"Taken in moderation or used in cooking, (curcumins) are quite useful. But I wouldn't go to a health food store and start taking four grams of curcumin a day, as was done in this study," Mehta said. SOURCE: http://bit.ly/HEnC5f

(Reporting from New York by Genevra Pittman at Reuters Health; editing by Elaine Lies and Jeremy Laurence)

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