HIV 阳性患者行初次全髋关节和全膝关节置换术的合并症和围手术期并发症。

Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty.

机构信息

Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MUW 320, San Francisco, CA 94143, USA.

出版信息

J Bone Joint Surg Am. 2013 Jun 5;95(11):1028-36. doi: 10.2106/JBJS.L.00269.

DOI:10.2106/JBJS.L.00269

PMID:23780541

Abstract

BACKGROUND

Highly active antiretroviral therapy has prolonged the lifespan of individuals infected with human immunodeficiency virus (HIV). We hypothesized that the number of primary total joint arthroplasties performed in this population has been increasing and that HIV infection is not an independent risk factor for postoperative complications.

METHODS

The Nationwide Inpatient Sample for the years 2000 through 2008 was queried to identify patients who underwent primary total joint arthroplasty. HIV, comorbidities, and complications were identified with use of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes. Data were analyzed with use of multivariate logistic regression, the Pearson chi-square test, and the Mann-Kendall trend test.

RESULTS

Of the estimated 5,681,024 admissions for primary total hip and knee arthroplasty in the United States during this period, 8229 (0.14%) were in patients who had HIV. Compared with HIV-negative patients (controls), infected patients were more likely to be younger, be male, and have a history of osteonecrosis, liver disease, drug use, and coagulopathy. The number of total hip and total knee arthroplasties in HIV-positive patients increased from 2000 to 2008 (p < 0.05). Seventy-nine percent (6499) of the total joint arthroplasties in the HIV-positive patients involved the hip. Compared with HIV-negative patients undergoing total hip arthroplasty, HIV-positive patients were more likely to develop acute renal failure (1.3% compared with 0.8%, p = 0.04), develop a wound infection (0.6% compared with 0.3%, p = 0.02), and undergo postoperative irrigation and debridement (0.2% compared with 0.1%, p = 0.01). They were less likely to have a myocardial infarction (0.4% compared with 0.9%, p = 0.04). There was no difference in total complications (8.3% compared with 7.8%, p = 0.52). Similarly, there was no difference in total complications in patients undergoing total knee arthroplasty (7.8% compared with 8.0%, p = 0.76). HIV was not an independent risk factor for complications in total hip arthroplasty (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.95 to 1.47) or total knee arthroplasty (OR, 0.78; 95% CI, 0.49 to 1.25).

CONCLUSIONS

The incidence of primary total joint arthroplasty in HIV-positive patients has been increasing. These patients were at slightly higher risk of certain immediate postoperative complications because of a higher rate of medical comorbidities. HIV infection was not an independent risk factor for the total rate of perioperative complications.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

高效抗逆转录病毒疗法延长了感染人类免疫缺陷病毒（HIV）个体的寿命。我们假设，在该人群中进行的初次全关节置换术的数量一直在增加，并且 HIV 感染不是术后并发症的独立危险因素。

方法

对 2000 年至 2008 年的全国住院患者样本进行了查询，以确定接受初次全关节置换术的患者。使用 ICD-9-CM（国际疾病分类，第 9 次修订，临床修正版）代码识别 HIV、合并症和并发症。使用多变量逻辑回归、Pearson χ2 检验和 Mann-Kendall 趋势检验进行数据分析。

结果

在此期间，美国估计有 5681024 例初次全髋关节和膝关节置换术住院患者，其中 8229 例（0.14%）为 HIV 阳性患者。与 HIV 阴性患者（对照组）相比，感染患者更年轻，更可能为男性，且有骨坏死、肝病、药物使用和凝血障碍病史。HIV 阳性患者的全髋关节和全膝关节置换术数量从 2000 年增加到 2008 年（p < 0.05）。在 HIV 阳性患者中，有 79%（6499 例）的全关节置换术涉及髋关节。与接受全髋关节置换术的 HIV 阴性患者相比，HIV 阳性患者更可能发生急性肾衰竭（1.3%比 0.8%，p = 0.04）、发生伤口感染（0.6%比 0.3%，p = 0.02）和接受术后灌洗和清创术（0.2%比 0.1%，p = 0.01）。他们发生心肌梗死的可能性较小（0.4%比 0.9%，p = 0.04）。总并发症发生率无差异（8.3%比 7.8%，p = 0.52）。同样，全膝关节置换术患者的总并发症发生率也无差异（7.8%比 8.0%，p = 0.76）。HIV 不是全髋关节置换术（比值比[OR]，1.18；95%置信区间[CI]，0.95 至 1.47）或全膝关节置换术（OR，0.78；95%CI，0.49 至 1.25）并发症的独立危险因素。