Michaud Kaleb, Fehringer Edward V, Garvin Kevin, O'Dell James R, Mikuls Ted R
Arthritis Res Ther. 2013;15(6):R195. doi: 10.1186/ar4385.
Serious infection, cardiovascular disease, and mortality are increased in rheumatoid arthritis (RA). Whether RA affects the risk for these complications after total joint arthroplasty (TJA) is unknown, we hypothesize that it does. We compared the occurrence of 30-day postoperative complications and mortality in a large cohort of RA and osteoarthritis (OA) patients undergoing hip or knee TJA.
Analyses included 7-year data from the Veterans Affairs Surgical Quality Improvement Program. The 30-day complications were compared by diagnosis by using logistic regression, and long-term mortality was examined by using Cox proportional hazards regression. All analyses were adjusted for age, sex, and clustering by surgical site. Additional covariates included sociodemographics, comorbidities, health behaviors, and operative risk factors.
The 34,524 patients (839 RA, 33,685 OA) underwent knee (65.9%) or hip TJA. Patients were 95.7% men with a mean (SD) age of 64.4 (10.7) years and had 3,764 deaths over a mean follow-up of 3.7 (2.3) years. Compared with OA patients, those with RA were significantly more likely to require a return to the operating room (odds ratio (OR), 1.45 (95% CI, 1.08 to 1.94), but had similar rates of 30-day postoperative infection, OR 1.02 (0.72 to 1.47), cardiovascular events, OR 0.69 (0.37 to 1.28), and mortality, OR 0.94 (0.38 to 2.33). RA was associated with a significantly higher long-term mortality; hazard ratio (HR), 1.22 (1.00 to 1.49).
In this study of US veterans, RA patients were not at an increased risk for short-term mortality or other major complications after TJA, although they returned to the operating room more often and had increased long-term mortality.
类风湿关节炎（RA）患者发生严重感染、心血管疾病及死亡的风险增加。RA是否会影响全关节置换术（TJA）后出现这些并发症的风险尚不清楚，我们推测会有影响。我们比较了一大群接受髋或膝TJA的RA患者和骨关节炎（OA）患者术后30天并发症及死亡的发生率。
分析纳入了退伍军人事务部外科质量改进计划的7年数据。采用逻辑回归按诊断比较30天并发症情况，采用Cox比例风险回归分析长期死亡率。所有分析均对年龄、性别及手术部位聚类进行了校正。其他协变量包括社会人口统计学特征、合并症、健康行为及手术风险因素。
34524例患者（839例RA，33685例OA）接受了膝（65.9%）或髋TJA。患者95.7%为男性，平均（标准差）年龄64.4（10.7）岁，平均随访3.7（2.3）年期间有3764例死亡。与OA患者相比，RA患者更有可能需要返回手术室（比值比（OR），1.45（95%置信区间，1.08至1.94）），但术后30天感染率相似，OR为1.02（0.72至1.47），心血管事件发生率相似，OR为0.69（0.37至1.28），死亡率相似，OR为0.94（0.38至2.33）。RA与显著更高的长期死亡率相关；风险比（HR）为1.22（1.00至1.49）。
在这项针对美国退伍军人的研究中，RA患者TJA后短期死亡或其他主要并发症风险并未增加，尽管他们更常返回手术室且长期死亡率有所升高。
