初次全膝关节置换术术前大剂量糖皮质激素的安全性问题。

Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement.

机构信息

Section of Surgical Pathophysiology, 7621, Rigshospitalet, University of Copenhagen, Blegdamsvej 9 DK-2100, Denmark.

The Lundbeck Foundation Centre for Fast-track Hip and Knee replacement, Rigshospitalet, University of Copenhagen, Blegdamsvej 9 DK-2100, Copenhagen, Denmark.

出版信息

Br J Anaesth. 2017 Aug 1;119(2):267-275. doi: 10.1093/bja/aex190.

DOI:10.1093/bja/aex190

PMID:28854533

Abstract

BACKGROUND

Preoperative single high-dose glucocorticoid may have early outcome benefits in total hip arthroplasty (THA) and knee arthroplasty (TKA), but long-term safety aspects have not been evaluated.

METHODS

From October 2013, the departments reporting to the prospective Lundbeck Foundation Database for Fast-track Hip and Knee Replacement introduced preoperative methylprednisolone (MP) 125 mg as part of a multimodal analgesic protocol in TKA. We analysed the risk of length of hospital stay (LOS) >4 days, 30 and 90 day readmissions in patients with MP vs patients having TKA before the use of MP and adjusted for comorbidity and place of surgery. An unadjusted comparison was specifically done to evaluate deep prosthetic infections.

RESULTS

Of a total of 3927 TKA procedures, 1442 received MP. Median LOS was 2 days in both groups, but the fraction with LOS >4 days was 6.0% vs 11.5% (P<0.001) in patients with MP vs those without, and with a reduced risk of LOS >4 days in adjusted analysis [odds ratio (OR) 0.51; confidence interval (CI) 0.39-0.68; P <0.001]. Readmission rates were 5.6% (CI 4.5-6.9) vs 4.4% ( P =0.095) and 7.8% vs 7.3% ( P =0.53) at 30 and 90 days with and without MP, respectively.

CONCLUSIONS

In this detailed prospective cohort study, preoperative high-dose glucocorticoid administration was not associated with LOS >4 days, readmissions or infectious complications in TKA patients without contraindications.

摘要

背景

术前单次大剂量糖皮质激素可能对全髋关节置换术（THA）和膝关节置换术（TKA）有早期获益，但长期安全性尚未得到评估。

方法

自 2013 年 10 月起，向隆德基金会快速髋关节和膝关节置换数据库报告的部门在 TKA 中引入了术前甲泼尼龙（MP）125mg，作为多模式镇痛方案的一部分。我们分析了接受 MP 的患者与接受 MP 前接受 TKA 的患者相比，住院时间（LOS）>4 天、30 天和 90 天再入院的风险，并根据合并症和手术部位进行了调整。特别进行了未经调整的比较，以评估深部假体感染。

结果

在总共 3927 例 TKA 手术中，有 1442 例接受了 MP。两组的 LOS 中位数均为 2 天，但接受 MP 的患者中 LOS>4 天的比例为 6.0%，而未接受 MP 的患者为 11.5%（P<0.001），调整分析后 LOS>4 天的风险降低[优势比（OR）0.51；置信区间（CI）0.39-0.68；P<0.001]。30 天和 90 天的再入院率分别为 5.6%（CI 4.5-6.9）和 4.4%（P=0.095），而接受和不接受 MP 的患者分别为 7.8%和 7.3%（P=0.53）。