90 天后原发性肩部关节置换术后的死亡率及其预测因素：1976-2008 年 4019 例患者的分析。
Ninety day mortality and its predictors after primary shoulder arthroplasty: an analysis of 4,019 patients from 1976-2008.
机构信息
Medicine Service and Center for Surgical Medical Acute care Research and Transitions-C-SMART, Birmingham VA Medical Center, Birmingham, AL, USA.
出版信息
BMC Musculoskelet Disord. 2011 Oct 12;12:231. doi: 10.1186/1471-2474-12-231.
BACKGROUND
Examine 90-day postoperative mortality and its predictors following shoulder arthroplasty
METHODS
We identified vital status of all adults who underwent primary shoulder arthroplasty (Total shoulder arthroplasty (TSA) or humeral head replacement (HHR)) at the Mayo Clinic from 1976-2008, using the prospectively collected information from Total Joint Registry. We used univariate logistic regression models to assess the association of gender, age, body mass index, American Society of Anesthesiologist (ASA) class, Deyo-Charlson comorbidity index, an underlying diagnosis and implant fixation with odds of 90-day mortality after TSA or HHR. Multivariable models additionally adjusted for the type of surgery (TSA versus HHR). Adjusted Odds ratio (OR) with 95% confidence interval (CI) were calculated.
RESULTS
Twenty-eight of the 3, 480 patient operated died within 90-days of shoulder arthroplasty (0.8%). In multivariable-adjusted analyses, the following factors were associated with significantly higher odds of 90-day mortality: higher Deyo-Charlson index (OR, 1.54; 95% CI:1.39, 1.70; p < 0.001); a diagnosis of tumor (OR, 16.2; 95%CI:7.1, 36.7); and ASA class III (OR, 3.57; 95% CI:1.29, 9.91; p = 0.01) or class IV (OR, 13.4; 95% CI:2.44, 73.86; p = 0.003). BMI ≥ 30 was associated with lower risk of 90-day mortality (OR, 0.25; 95% CI:0.08, 0.78). In univariate analyses, patients undergoing TSA had significantly lower 90-day mortality of 0.4% (8/2, 580) compared to 1% in HHR (20/1, 411) (odds ratio, 0.22 (95% CI: 0.10, 0.50); p = 0.0003).
CONCLUSIONS
90-day mortality following shoulder arthroplasty was low. An underlying diagnosis of tumor, higher comorbidity and higher ASA class were risk factors for higher 90-day mortality, while higher BMI was protective. Pre-operative comorbidity management may impact 90-day mortality following shoulder arthroplasty. A higher unadjusted mortality in patients undergoing TSA versus HHR may indicate the underlying differences in patients undergoing these procedures.
背景
检查肩关节炎手术后 90 天的死亡率及其预测因素
方法
我们使用前瞻性收集的来自全关节登记处的数据，确定了 1976 年至 2008 年期间在梅奥诊所接受初次肩关节炎置换术（全肩关节置换术（TSA）或肱骨头置换术（HHR））的所有成年人的存活状态。我们使用单变量逻辑回归模型来评估性别、年龄、体重指数、美国麻醉师协会（ASA）分级、Deyo-Charlson 合并症指数、基础诊断和植入物固定与 TSA 或 HHR 后 90 天死亡率的比值比（OR）之间的关联。多变量模型还调整了手术类型（TSA 与 HHR）。计算调整后的比值比（OR）及其 95%置信区间（CI）。
结果
在 3480 名接受手术的患者中，有 28 名在肩关节炎手术后 90 天内死亡（0.8%）。在多变量调整分析中，以下因素与 90 天死亡率显著相关：Deyo-Charlson 指数较高（OR，1.54；95%CI：1.39，1.70；p <0.001）；诊断为肿瘤（OR，16.2；95%CI：7.1，36.7）；ASA 分级 III（OR，3.57；95%CI：1.29，9.91；p = 0.01）或 IV（OR，13.4；95%CI：2.44，73.86；p = 0.003）。BMI≥30 与 90 天死亡率降低相关（OR，0.25；95%CI：0.08，0.78）。在单变量分析中，接受 TSA 的患者 90 天死亡率显著较低，为 0.4%（8/2580），而接受 HHR 的患者为 1%（20/411）（OR，0.22（95%CI：0.10，0.50）；p = 0.0003）。
结论
肩关节炎手术后 90 天死亡率较低。肿瘤的基础诊断、较高的合并症和较高的 ASA 分级是较高 90 天死亡率的危险因素，而较高的 BMI 则具有保护作用。术前合并症管理可能会影响肩关节炎置换术后 90 天的死亡率。TSA 患者与 HHR 患者相比，未调整死亡率较高可能表明接受这些手术的患者存在潜在差异。
Zotero 插件