Somayaji Ranjani, Barnabe Cheryl, Martin Liam
Department of Medicine, Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, Health Sciences, University of Calgary, Calgary, Alberta, Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Open Rheumatol J. 2013 Nov 29;7:119-24. doi: 10.2174/1874312920131210005.
Determine risk factors for infection following hip or knee total joint arthroplasty in patients with rheumatoid arthritis.
All rheumatoid arthritis patients with a hip or knee arthroplasty between years 2000 and 2010 were identified from population-based administrative data from the Calgary Zone of Alberta Health Services. Clinical data from patient charts during the hospital admission and during a one year follow-up period were extracted to identify incident infections.
We identified 381 eligible procedures performed in 259 patients (72.2% female, mean age 63.3 years, mean body mass index 27.6 kg/m2). Patient comorbidities were hypertension (43.2%), diabetes (10.4%), coronary artery disease (13.9%), smoking (10.8%) and obesity (32%). Few infectious complications occurred: surgical site infections occurred within the first year after 5 procedures (2 joint space infections, 3 deep incisional infections). Infections of non-surgical sites (urinary tract, skin or respiratory, n=4) complicated the hospital admission. The odds ratio for any post-arthroplasty infection was increased in patients using prednisone doses exceeding 15 mg/day (OR 21.0, 95%CI 3.5-127.2, p=<0.001), underweight patients (OR 6.0, 95%CI 1.2-30.9, p=0.033) and those with known coronary artery disease (OR 5.1, 95%CI 1.3-19.8, p=0.017). Types of disease-modifying therapy, age, sex, and other comorbidities were not associated with an increased risk for infection.
Steroid doses over 15 mg/day, being underweight and having coronary artery disease were associated with significant increases in the risk of post-arthroplasty infection in rheumatoid arthritis. Maximal tapering of prednisone and comorbidity risk reduction must be addressed in the peri-operative management strategy.
确定类风湿关节炎患者行髋或膝关节全关节置换术后感染的危险因素。
从艾伯塔省卫生服务局卡尔加里地区基于人群的行政数据中，识别出2000年至2010年间所有行髋或膝关节置换术的类风湿关节炎患者。提取患者住院期间及1年随访期内病历中的临床数据，以确定感染事件。
我们识别出259例患者接受的381例符合条件的手术（女性占72.2%，平均年龄63.3岁，平均体重指数27.6kg/m²）。患者的合并症包括高血压（43.2%）、糖尿病（10.4%）、冠状动脉疾病（13.9%）、吸烟（10.8%）和肥胖（32%）。感染并发症很少发生：5例手术（2例关节间隙感染、3例深部切口感染）术后第一年内发生手术部位感染。非手术部位感染（尿路感染、皮肤感染或呼吸道感染，n = 4）使住院情况复杂化。使用泼尼松剂量超过15mg/天的患者（比值比21.0，95%可信区间3.5 - 127.2，p < 0.001）、体重过轻的患者（比值比6.0，95%可信区间1.2 - 30.9，p = 0.033）以及已知患有冠状动脉疾病的患者（比值比5.1，95%可信区间1.3 - 19.8，p = 0.017）术后发生任何感染的比值比增加。改变病情的治疗类型、年龄、性别和其他合并症与感染风险增加无关。
泼尼松剂量超过15mg/天、体重过轻和患有冠状动脉疾病与类风湿关节炎患者术后感染风险显著增加相关。围手术期管理策略必须解决泼尼松的最大程度减量和降低合并症风险的问题。
