关节置换术与关节镜手术的心肌梗死风险：手术类型有多重要？

Myocardial Infarction Risk in Arthroplasty vs Arthroscopy: How Much Does Procedure Type Matter?

机构信息

Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.

Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas.

出版信息

J Arthroplasty. 2017 Jan;32(1):246-251. doi: 10.1016/j.arth.2016.06.033. Epub 2016 Jun 29.

DOI:10.1016/j.arth.2016.06.033

PMID:27480828

Abstract

BACKGROUND

This study aimed at assessing short-term risk of serious cardiac events after elective total joint arthroplasty (TJA) as compared to a less-invasive procedure, knee arthroscopy (KA).

METHODS

Patients who underwent elective primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or KA from 2011 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. A 1:1 propensity matching was used to generate 2 control cohorts of KA patients with similar characteristics. Bivariate and multivariate analyses were assessed using perioperative variables.

RESULTS

A total of 24,203 THA, 21,740 TKA, and 45,943 KA patients were included. Bivariate analysis revealed significantly higher rates of serious 30-day cardiac events (myocardial infarction or cardiac arrest) among THA (0.15% vs 0.05%, P < .001) and TKA patients (0.14% vs 0.05%, P < .03) vs KA controls. In multivariate analysis controlling for patient characteristics and comorbidities, THA and TKA were associated with a 2.61 and 1.98 times odds of serious 30-day cardiac events as compared to controls (P ≤ .03 for both). Additional independent predictors of serious 30-day cardiac events included age, smoking, cardiac disease, and American Society of Anesthesiologists class 3/4. In the THA and TKA cohorts, serious cardiac events occurred within the first 3 days postoperation compared to 4 days in controls.

CONCLUSION

After controlling for patient characteristics and comorbidities, TJA increased the short-term risk of serious cardiac event compared to a less-invasive procedure. This information better quantifies the risk differential for patients considering surgery as they engage in shared decision making with their providers. In addition, our data may have an impact on perioperative management of antithrombotic medications used in patients with cardiac disease. The median time in days to serious cardiac event was 2 in THA and 3 in TKA vs 4 in KA, which may have implications in postoperative monitoring of patients after surgery.

摘要

背景

本研究旨在评估择期全关节置换术（TJA）与微创手术膝关节镜检查（KA）相比，术后短期发生严重心脏事件的风险。

方法

在美国外科医师学会国家手术质量改进计划数据库中，确定了 2011 年至 2014 年期间接受择期初次全髋关节置换术（THA）、全膝关节置换术（TKA）或 KA 的患者。使用 1:1 倾向匹配生成了具有相似特征的 2 个 KA 患者对照队列。使用围手术期变量评估了双变量和多变量分析。

结果

共纳入 24203 例 THA、21740 例 TKA 和 45943 例 KA 患者。双变量分析显示，THA（0.15%比 0.05%，P<0.001）和 TKA 患者（0.14%比 0.05%，P<0.03）严重 30 天心脏事件（心肌梗死或心脏骤停）发生率显著更高。在控制患者特征和合并症的多变量分析中，THA 和 TKA 与严重 30 天心脏事件的发生风险比对照增加了 2.61 和 1.98 倍（均 P≤0.03）。严重 30 天心脏事件的其他独立预测因素包括年龄、吸烟、心脏病和美国麻醉师协会 3/4 级。在 THA 和 TKA 队列中，严重心脏事件发生在术后前 3 天，而对照组为 4 天。

结论

在控制患者特征和合并症后，TJA 与微创手术相比，增加了严重心脏事件的短期风险。这一信息更好地量化了考虑手术的患者的风险差异，因为他们与提供者共同做出决策。此外，我们的数据可能会对心脏病患者使用的抗血栓药物的围手术期管理产生影响。严重心脏事件的中位时间在 THA 中为 2 天，在 TKA 中为 3 天，在 KA 中为 4 天，这可能对术后患者的监测有影响。