Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, Ohio.
Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska.
J Arthroplasty. 2018 Apr;33(4):976-982. doi: 10.1016/j.arth.2017.11.014. Epub 2017 Nov 13.
Despite the ubiquitous use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in older adults, little is known about the multimorbidity (MM) profile of this patient population. This study evaluates the temporal trends of MM, hypothesizing that patients with MM have had an increasingly greater representation in THA and TKA patients over time.
Data on a US representative sample of older adults from the linked Health and Retirement Study and Medicare data from 1993 to 2012 were used. The Health and Retirement Study is a biennial survey that collects data on a broad array of measures, including self-reported chronic conditions and geriatric syndromes, which were used to account for MM. Medicare data were used to identify fee-for-service Medicare beneficiaries who underwent THA (n = 479) or TKA (n = 998) during the study years, which were grouped into 3 periods: 1993-1999, 2000-2006, and 2007-2012. Multivariable logistic regression analysis was conducted to obtain age-, gender-, and race-adjusted time trends for MM.
Compared to the earliest study period, and for both THA and TKA patients, there were significantly fewer patients with stroke and/or poor cognitive performance in the most recent study period. In addition, more TKA than THA patients presented with 2+ chronic conditions. Nearly 70% presented with co-occurring chronic conditions and geriatric syndromes, and this percentage did not change significantly over time.
The high representation of THA and TKA patients presenting with co-occurring chronic conditions and geriatric syndromes in this patient population warrants detailed exploration of the effects of geriatric syndromes on postoperative outcomes.
尽管全髋关节置换术（THA）和全膝关节置换术（TKA）在老年人中广泛应用，但对于这一患者群体的多种合并症（MM）情况知之甚少。本研究评估了 MM 的时间趋势，假设随着时间的推移，患有 MM 的患者在 THA 和 TKA 患者中的比例越来越大。
使用来自美国有代表性的老年人群的健康与退休研究（Health and Retirement Study）和医疗保险数据（Medicare data）的相关数据。健康与退休研究是一项两年一次的调查，收集了广泛的测量数据，包括自我报告的慢性疾病和老年综合征，这些数据被用来计算 MM。医疗保险数据用于确定在研究期间接受 THA（n=479）或 TKA（n=998）的按服务收费医疗保险受益人的数据，这些患者被分为 3 个时期：1993-1999 年、2000-2006 年和 2007-2012 年。采用多变量逻辑回归分析获得年龄、性别和种族调整后的 MM 时间趋势。
与最早的研究期间相比，在最近的研究期间，THA 和 TKA 患者中患有中风和/或认知功能障碍的患者明显减少。此外，与 THA 患者相比，更多的 TKA 患者患有 2 种及以上慢性疾病。近 70%的患者同时患有慢性疾病和老年综合征，且这一比例在过去的时间内并未发生显著变化。
在这一患者群体中，THA 和 TKA 患者中同时存在多种合并症和老年综合征的比例很高，这需要详细探讨老年综合征对术后结果的影响。
