初次全膝关节置换术后的早期死亡。

Early death following primary total knee arthroplasty.

机构信息

Department of Orthopaedic Surgery, University of Bristol, Bristol Implant Research Centre, Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom.

出版信息

J Bone Joint Surg Am. 2011 May 18;93(10):948-53. doi: 10.2106/JBJS.J.00425.

DOI:10.2106/JBJS.J.00425

PMID:21593371

Abstract

BACKGROUND

Total knee arthroplasty carries major risks, including death. Conventional studies have compared the mortality rate following total knee arthroplasty with standardized mortality ratios or age and sex-matched populations. The purpose of the present study was to compare the mortality rate in a population of patients who were managed with total knee arthroplasty with that in patients who were awaiting surgery.

METHODS

All patients undergoing primary total knee arthroplasty from 2000 to 2007 at a single institution were recorded. In the same period, all patients who were added to the waiting list for total knee arthroplasty were recorded. The mortality rate and time to death were calculated, and death certificates were retrieved for those who died within thirty or ninety days after the index event.

RESULTS

Two thousand, six hundred and ninety-five patients undergoing primary total knee arthroplasty were used for the thirty-day mortality calculation, and 2527 were used for the ninety-day mortality calculation. These patients were compared with 5857 and 5689 patients who were added to the waiting list for the thirty-day and ninety-day mortality calculations, respectively. There was no difference between the populations in terms of age or sex (p > 0.05). The thirty-day mortality following surgery was significantly greater for the surgery group (0.371%; 95% confidence interval, 0.202% to 0.682%) than for the waiting list group (0.0683%; 95% confidence interval, 0.0266% to 0.1755%) (odds ratio, 5.45; 95% confidence interval, 1.81 to 16.43). The ninety-day mortality was also significantly greater for the surgery group (0.792%; 95% confidence interval, 0.513% to 1.219%) than for the waiting list group (0.387%; 95% confidence interval, 0.256% to 0.585%) (odds ratio, 2.05; 95% confidence interval, 1.13 to 3.74).

CONCLUSIONS

Primary total knee arthroplasty is associated with an increased risk of death at thirty and ninety days after the operation when compared with a population awaiting the same procedure. Increasing age was a risk factor for death following total knee arthroplasty.

摘要

背景

全膝关节置换术存在重大风险，包括死亡。传统研究将全膝关节置换术后的死亡率与标准化死亡率比或年龄和性别匹配人群进行了比较。本研究的目的是比较接受全膝关节置换术的患者人群与等待手术的患者人群的死亡率。

方法

记录了 2000 年至 2007 年在一家机构接受初次全膝关节置换术的所有患者。同期，记录了所有被添加到全膝关节置换术等候名单的患者。计算死亡率和死亡时间，并为在指数事件后 30 天或 90 天内死亡的患者检索死亡证明。

结果

2695 例接受初次全膝关节置换术的患者用于计算 30 天死亡率，2527 例用于计算 90 天死亡率。这些患者与分别被添加到 30 天和 90 天死亡率计算等候名单的 5857 例和 5689 例患者进行了比较。两组人群在年龄和性别方面无差异（p>0.05）。手术组术后 30 天死亡率显著高于等候名单组（0.371%；95%置信区间，0.202%至 0.682%）（比值比，5.45；95%置信区间，1.81 至 16.43）。手术组 90 天死亡率也显著高于等候名单组（0.792%；95%置信区间，0.513%至 1.219%）（比值比，2.05；95%置信区间，1.13 至 3.74）。