Otero Jesse E, Graves Christopher M, Gao Yubo, Olson Tyler S, Dickinson Christopher C, Chalus Rhonda J, Vittetoe David A, Goetz Devon D, Callaghan John J
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Des Moines Orthopaedic Surgeons, Des Moines, Iowa.
J Arthroplasty. 2016 Dec;31(12):2746-2749. doi: 10.1016/j.arth.2016.07.040. Epub 2016 Aug 10.
Retrospective analyses have demonstrated correlation between patient-reported allergies and negative outcomes after total joint arthroplasty. We sought to validate these observations in a prospective cohort.
One hundred forty-four patients undergoing total hip arthroplasty and 302 patients undergoing total knee arthroplasty were prospectively enrolled. Preoperatively, patients listed their allergies and completed the Medical Outcomes Study Short Form 36 (SF-36) and the Charlson Comorbidity Index (CCI) Questionnaire. At a mean of 17 months (range 12-25 months) postoperatively, SF-36, CCI, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained by telephone survey. Regression analysis was used to determine the strength of correlation between patient age, comorbidity burden, and number of allergies and outcome measurements.
In 446 patients, 273 reported at least 1 allergy. The number of allergies reported ranged from 0 to 33. Penicillin or its derivative was the most frequently reported allergy followed by sulfa, environmental allergen, and narcotic pain medication. Patients reporting at least 1 allergy had a significantly lower postoperative SF-36 Physical Component Score compared to those reporting no allergies (51.3 vs 49.4, P = .01). The SF-36 postoperative Mental Component Score was no different between groups. Multivariate regression analysis showed that age and patient reported allergies, but not comorbidities, were independently associated with worse postoperative SF-36 Physical Component Summary (PCS) and WOMAC score. Patients with allergies experienced the same improvement in SF-36 PCS as those without an allergy. Comorbidities did not correlate with patient-reported function postoperatively.
Patients who report allergies have lower postoperative outcome scores but may experience the same increment in improvement after total joint arthroplasty.
回顾性分析表明，患者报告的过敏反应与全关节置换术后的不良后果之间存在相关性。我们试图在前瞻性队列中验证这些观察结果。
前瞻性纳入144例行全髋关节置换术的患者和302例行全膝关节置换术的患者。术前，患者列出他们的过敏情况，并完成医学结果研究简表36（SF-36）和查尔森合并症指数（CCI）问卷。术后平均17个月（范围12 - 25个月），通过电话调查获取SF-36、CCI和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）。采用回归分析来确定患者年龄、合并症负担、过敏数量与结果测量之间的相关强度。
在446例患者中，273例报告至少有一种过敏。报告的过敏数量范围为0至33种。青霉素或其衍生物是最常报告的过敏，其次是磺胺类、环境过敏原和麻醉性止痛药。报告至少一种过敏的患者术后SF-36身体成分评分显著低于未报告过敏的患者（51.3对49.4，P = .01）。两组之间术后SF-36心理成分评分无差异。多变量回归分析表明，年龄和患者报告的过敏反应而非合并症与术后较差的SF-36身体成分总结（PCS）和WOMAC评分独立相关。有过敏反应的患者在SF-36 PCS方面的改善与无过敏反应的患者相同。合并症与患者术后报告的功能无关。
报告过敏的患者术后结果评分较低，但在全关节置换术后可能会有相同程度的改善。
