Weiss Rüdiger J, Garellick Göran, Kärrholm Johan, Hailer Nils P
From the Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm; Swedish Hip Arthroplasty Register, and Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg; Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.R.J. Weiss, MD PhD, Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, and Swedish Hip Arthroplasty Register, Department of Orthopedics, Sahlgrenska University Hospital; G. Garellick, MD, PhD, Swedish Hip Arthroplasty Register, Department of Orthopedics, and Institute of Clinical Sciences, Sahlgrenska University Hospital; J. Kärrholm, MD, PhD, Swedish Hip Arthroplasty Register, Department of Orthopedics, and Institute of Clinical Sciences, Sahlgrenska University Hospital; N.P. Hailer, MD, Swedish Hip Arthroplasty Register, Department of Orthopedics, Sahlgrenska University Hospital, and Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital.
J Rheumatol. 2016 Jul;43(7):1320-7. doi: 10.3899/jrheum.151287. Epub 2016 May 1.
We analyzed early mortality after total hip arthroplasty (THA) in patients with inflammatory arthritis (IA), adjusting for medical comorbidities and socioeconomic background.
Data on 6690 patients with IA who underwent THA during 1992-2012 were extracted from the Swedish Hip Arthroplasty Register. Data on comorbidity, measured using the Charlson Comorbidity Index (CCI), and socioeconomic data were gathered from the Swedish National Inpatient Register and Statistics Sweden. The CCI was divided into low (0), moderate (1-2), and high (> 2). Cox proportional hazards models were fitted to calculate adjusted HR of early mortality, with 95% CI.
Twenty-five patients (0.4%) died within 0-90 days, giving a 90-day unadjusted survival rate of 99.6% (CI 99.5-99.8). Comorbidity was associated with an increased risk of death within 90 days postoperatively [high vs low CCI: adjusted HR 9.0 (CI 1.6-49.9)]. There was a trend toward lower risk of death during the period 1999-2005, although patients operated on during this period had more comorbidities than those operated on from 1992 to 1998. A large proportion of patients was re-admitted to hospital within 90 days after the index procedure (30.2%), but rarely for cardiovascular reasons.
Medical comorbidity and an age above 75 years are associated with a substantial increase in the risk of early death after THA in patients with IA. Awareness of potential risk factors may alert clinicians and thus improve perioperative care.
我们分析了炎性关节炎（IA）患者全髋关节置换术（THA）后的早期死亡率，并对医疗合并症和社会经济背景进行了调整。
从瑞典髋关节置换登记处提取了1992年至2012年期间接受THA的6690例IA患者的数据。使用Charlson合并症指数（CCI）测量的合并症数据以及社会经济数据来自瑞典国家住院登记处和瑞典统计局。CCI分为低（0）、中（1-2）和高（>2）。采用Cox比例风险模型计算调整后的早期死亡率HR，并给出95%置信区间。
25例患者（0.4%）在0至90天内死亡，90天未调整生存率为99.6%（CI 99.5-99.8）。合并症与术后90天内死亡风险增加相关[高CCI与低CCI相比：调整后HR 9.0（CI 1.6-49.9）]。1999年至2005年期间死亡风险有降低趋势，尽管在此期间接受手术的患者比1992年至1998年接受手术的患者合并症更多。很大一部分患者在初次手术后90天内再次入院（30.2%），但很少是因为心血管原因。
医疗合并症和75岁以上年龄与IA患者THA后早期死亡风险大幅增加相关。认识潜在风险因素可能会提醒临床医生，从而改善围手术期护理。
