美国择期初次全髋关节和全膝关节置换术后的住院患者肺栓塞。

Inpatient pulmonary embolism after elective primary total hip and knee arthroplasty in the United States.

机构信息

Department of Orthopaedics, University of Maryland Medical Center, 11SB, 22 South Greene Street, Baltimore, MD 21201. E-mail address for U. Zahir:

出版信息

J Bone Joint Surg Am. 2013 Nov 20;95(22):e175. doi: 10.2106/JBJS.L.00466.

DOI:10.2106/JBJS.L.00466

PMID:24257675

Abstract

BACKGROUND

The incidence of inpatient pulmonary embolism in patients who have elective primary hip and knee arthroplasty in the United States is unknown. Prior studies have included patients with cancer, trauma, or revisions. The goal of this study was to determine the incidence and risks of inpatient pulmonary embolism after elective arthroplasty by type of procedure.

METHODS

We used the 1998 to 2009 Healthcare Cost and Utilization Project Nationwide Inpatient Sample for this retrospective cohort study. Patients who were sixty years of age or older and underwent elective primary total hip or knee arthroplasty were included. The study variable was the type of arthroplasty: total hip, total knee, or two joints. Inpatient pulmonary embolism was the primary outcome; mortality was secondary. Logistic regression determined the adjusted odds ratios of inpatient pulmonary embolism by procedure, adjusting for age, sex, Charlson Comorbidity Index, atrial fibrillation, and surgical indication.

RESULTS

Records represented 5,044,403 hospital discharges after primary total hip or knee arthroplasty. Total knee arthroplasty comprised 66% of the admissions. Less than 5% of patients had two joint procedures. The overall incidence of pulmonary embolism was 0.358% (95% confidence interval [CI], 0.338, 0.378). The incidence of pulmonary embolism differed by procedure and was highest among patients who had two-joint arthroplasty (0.777%; 95% CI, 0.677, 0.876), was lowest in recipients of total hip arthroplasty (0.201%; 95% CI, 0.179, 0.223), and was intermediate in patients who had total knee arthroplasty (0.400%; 95% CI, 0.377, 0.423). The adjusted odds ratios of pulmonary embolism in patients who had two joint procedures were 3.89 times higher than among patients who had total hip arthroplasty, controlling for other factors.

CONCLUSIONS

Elective total knee arthroplasty is associated with a higher incidence and odds of inpatient pulmonary embolism than is total hip arthroplasty; multiple procedures pose the highest risk for pulmonary embolism and associated mortality.

摘要

背景

在美国，择期行初次髋膝关节置换术的住院患者中肺栓塞的发病率尚不清楚。既往研究纳入了癌症、创伤或翻修患者。本研究旨在通过手术类型确定择期关节置换术后住院患者肺栓塞的发病率和风险。

方法

我们采用了 1998 年至 2009 年全美住院患者医疗费用和利用项目的回顾性队列研究。纳入年龄 60 岁及以上、行择期初次全髋关节或全膝关节置换术的患者。研究变量为手术类型：全髋关节、全膝关节或两个关节。主要结局为住院肺栓塞；次要结局为死亡率。采用 logistic 回归分析，通过调整年龄、性别、Charlson 合并症指数、心房颤动和手术适应证，确定各手术类型的住院肺栓塞校正比值比。

结果

记录共代表 5044403 例初次全髋关节或全膝关节置换术后的住院患者。全膝关节置换术占住院人数的 66%。不到 5%的患者接受了两个关节手术。肺栓塞的总发病率为 0.358%（95%置信区间[CI]，0.338，0.378）。不同手术类型的肺栓塞发病率不同，两关节置换术患者的发病率最高（0.777%，95%CI，0.677，0.876），全髋关节置换术患者的发病率最低（0.201%，95%CI，0.179，0.223），全膝关节置换术患者的发病率居中（0.400%，95%CI，0.377，0.423）。校正其他因素后，两关节手术患者的肺栓塞校正比值比为全髋关节置换术患者的 3.89 倍。