单侧和双侧全膝关节置换术后的围手术期结果。
Perioperative outcomes after unilateral and bilateral total knee arthroplasty.
作者信息
Memtsoudis Stavros G, Ma Yan, González Della Valle Alejandro, Mazumdar Madhu, Gaber-Baylis Licia K, MacKenzie C Ronald, Sculco Thomas P
机构信息
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA.
出版信息
Anesthesiology. 2009 Dec;111(6):1206-16. doi: 10.1097/ALN.0b013e3181bfab7d.
BACKGROUND
The safety of bilateral total knee arthroplasties (BTKAs) during the same hospitalization remains controversial. The authors sought to study differences in perioperative outcomes between unilateral and BTKA and to further compare BTKAs performed during the same versus different operations during the same hospitalization.
METHODS
Nationwide Inpatient Sample data from 1998 to 2006 were analyzed. Entries for unilateral and BTKA procedures performed on the same day (simultaneous) and separate days (staged) during the same hospitalization were identified. Patient and healthcare system-related demographics were determined. The incidences of in-hospital mortality and procedure-related complications were estimated and compared between groups. Multivariate regression was used to identify independent risk factors for morbidity and mortality.
RESULTS
Despite younger average age and lower comorbidity burden, procedure-related complications and in-hospital mortality were more frequent after BTKA than after unilateral procedures (9.45% vs. 7.07% and 0.30% vs. 0.14%; P < 0.0001 each). An increased rate of complications was associated with a staged versus simultaneous approach with no difference in mortality (10.30% vs. 9.15%; P < 0.0001 and 0.29% vs. 0.26%; P = 0.2875). Independent predictors for in-hospital mortality included BTKA (simultaneous: odds ratio, 2.23 [95% confidence interval, 1.69-2.95]; P < 0.0001; staged: odds ratio, 2.01 [confidence interval, 1.28-3.41]; P = 0.0031), male sex (odds ratio, 2.02 [confidence interval, 1.75-2.34]; P < 0.0001), age older than 75 yr (odds ratio, 3.96 [confidence interval, 2.77-5.66]; P < 0.0001), and the presence of a number of comorbidities and complications.
CONCLUSION
BTKAs carry increased risk of perioperative morbidity and mortality compared with unilateral procedures. Staging BTKA procedures during the same hospitalization offers no mortality benefit and may even expose patients to increased morbidity.
背景
双侧全膝关节置换术（BTKA）在同一住院期间的安全性仍存在争议。作者旨在研究单侧与BTKA围手术期结果的差异，并进一步比较在同一住院期间同期与分期进行的BTKA。
方法
分析了1998年至2006年全国住院患者样本数据。确定了在同一住院期间同一天（同期）和不同天（分期）进行的单侧和BTKA手术记录。确定了患者和医疗系统相关的人口统计学特征。估计并比较了各组的院内死亡率和手术相关并发症的发生率。使用多变量回归来确定发病和死亡的独立危险因素。
结果
尽管BTKA患者的平均年龄较小且合并症负担较低，但与单侧手术相比，BTKA术后手术相关并发症和院内死亡率更常见（分别为9.45%对7.07%和0.30%对0.14%；P均<0.0001）。分期手术与同期手术相比并发症发生率增加，死亡率无差异（10.30%对9.15%；P<0.0001和0.29%对0.26%；P=0.2875）。院内死亡的独立预测因素包括BTKA（同期：比值比，2.23[95%置信区间，1.69-2.95]；P<0.0001；分期：比值比，2.01[置信区间，1.28-3.41]；P=0.0031）、男性（比值比，2.02[置信区间，1.75-2.34]；P<0.0001）、年龄大于75岁（比值比，3.96[置信区间，2.77-5.66]；P<0.0001）以及存在多种合并症和并发症。
结论
与单侧手术相比，BTKA的围手术期发病和死亡风险增加。在同一住院期间分期进行BTKA手术对死亡率没有益处，甚至可能使患者面临更高的发病率。
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