Clement N D, Jenkins P J, Brenkel I J, Walmsley P
Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
J Bone Joint Surg Br. 2012 Feb;94(2):200-4. doi: 10.1302/0301-620X.94B2.28114.
We report the general mortality rate after total knee replacement and identify independent predictors of survival. We studied 2428 patients: there were 1127 men (46%) and 1301 (54%) women with a mean age of 69.3 years (28 to 94). Patients were allocated a predicted life expectancy based on their age and gender. There were 223 deaths during the study period. This represented an overall survivorship of 99% (95% confidence interval (CI) 98 to 99) at one year, 90% (95% CI 89 to 92) at five years, and 84% (95% CI 82 to 86) at ten years. There was no difference in survival by gender. A greater mortality rate was associated with increasing age (p < 0.001), American Society of Anesthesiologists (ASA) grade (p < 0.001), smoking (p < 0.001), body mass index (BMI) < 20 kg/m(2) (p < 0.001) and rheumatoid arthritis (p < 0.001). Multivariate modelling confirmed the independent effect of age, ASA grade, BMI, and rheumatoid disease on mortality. Based on the predicted average mortality, 114 patients were predicted to have died, whereas 217 actually died. This resulted in an overall excess standardised mortality ratio of 1.90. Patient mortality after TKR is predicted by their demographics: these could be used to assign an individual mortality risk after surgery.
我们报告了全膝关节置换术后的总体死亡率，并确定了生存的独立预测因素。我们研究了2428例患者：其中男性1127例（46%），女性1301例（54%），平均年龄69.3岁（28至94岁）。根据患者的年龄和性别分配预期寿命。研究期间有223例死亡。这意味着1年时的总体生存率为99%（95%置信区间（CI）98%至99%），5年时为90%（95%CI 89%至92%），10年时为84%（95%CI 82%至86%）。性别之间的生存率没有差异。较高的死亡率与年龄增加（p<0.001）、美国麻醉医师协会（ASA）分级（p<0.001）、吸烟（p<0.001）、体重指数（BMI）<20kg/m²（p<0.001）和类风湿性关节炎（p<0.001）相关。多变量建模证实了年龄、ASA分级、BMI和类风湿疾病对死亡率的独立影响。根据预测的平均死亡率，预计有114例患者死亡，而实际死亡217例。这导致总体标准化死亡比为1.90。全膝关节置换术后患者的死亡率可通过其人口统计学特征预测：这些特征可用于确定术后个体死亡风险。
