Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk
Percentage of patients regardless of age undergoing a total knee or total hip replacement who are evaluated for the presence or absence of venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., History of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), Myocardial Infarction (MI), Arrhythmia and Stroke).
Last updated: January 15, 2026
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Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.
📖Clinical Rationale
Prior to a total knee or total hip replacement, the patient’s venous thromboembolic and cardiovascular risk should be evaluated. A population-based study of all Olmstead County, Minnesota, patients undergoing a total hip or knee arthroplasty from 1994 - 2008, reported that patients undergoing a total hip or total knee arthroplasty with a previous history of a cardiac event or a thromboembolic event were associated with an increased risk of a 90-day cardiac or thromboembolic event following surgery.
A study using the Danish national resident registries compared all patients undergoing a primary total hip replacement and total knee replacement from 1998 – 2007 to control groups not undergoing one of the procedures and found that the MI rate 2 weeks after total knee replacement was increased 31-fold compared to the control group. The MI rate 2 weeks after total hip replacement was increased 25-fold compared to the control group.
Any preoperative disease state should be identified and managed prior to surgery to minimize the risk of the surgical procedure. This measure is designed for use by physicians and eligible health care professionals managing ongoing care for all patients undergoing a total knee or hip replacement. This measure addresses the preoperative period.
📝Clinical Recommendations
Perioperative mortality and morbidity due to coronary artery disease (CAD) are untoward complications of noncardiac surgery. Major adverse cardiac events (MACE) after noncardiac surgery is often associated with prior CAD events. The stability and timing of a recent MI impact the incidence of perioperative morbidity and mortality. A validated risk-prediction tool can be useful in predicting the risk of perioperative MACE in patients undergoing noncardiac surgery. (Class IIa Level of Evidence: B)
📋Implementation Notes
This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period.
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