Durham University, Stockton, United Kingdom.
Northumbria Healthcare NHS Foundation Trust, Northumberland, United Kingdom.
J Bone Joint Surg Am. 2018 Mar 7;100(5):360-367. doi: 10.2106/JBJS.16.01198.
More than 75,000 total hip replacements were performed in England and Wales in 2014, and this figure is predicted to increase. Trends in mortality and complications following total hip replacement from 2005 to 2014 were evaluated to quantify risk and to identify "at-risk" groups to better inform recommendations for patient care.
Our primary analysis estimated 90-day inpatient mortality following total hip replacement using Hospital Episode Statistics data from 2005 to 2014. Secondary analyses explored 30-day rates of lower respiratory tract infection, renal failure, myocardial infarction, pulmonary embolism, deep-vein thrombosis, cerebrovascular accident, and Clostridium difficile. Hierarchical logistic regression was used to estimate population averages, adjusting for time and prognostic covariates.
From January 2005 to July 2014, a total of 540,623 total hip replacements were reported. The 90-day mortality rate dropped steadily, from 0.60% in 2005 to 0.15% in 2014. Reported postoperative complications (with the exception of lower respiratory tract infection and renal failure) reduced year-on-year, despite a steady rise in the average Charlson Comorbidity Index score. The 30-day rate of lower respiratory tract infection and renal failure increased from 0.54% to 0.84% and 0.21% to 1.09%, respectively. The risk of mortality was significantly higher for those who developed a lower respiratory tract infection (odds ratio [OR] = 42.3) or renal failure (OR = 36.5) than for those who developed pulmonary embolism (OR = 10.9) or deep-vein thrombosis (OR = 2.6).
Despite a population with increasing levels of comorbidity, indicators of quality of care improved from 2005 to 2014, with the exception of the rates of lower respiratory tract infection and renal failure. Postoperative care should focus on reducing the risk of lower respiratory tract infection and renal failure, both of which increased and were strongly associated with mortality. Moreover, they appeared to occur in identifiable high-risk groups; modifications to routine care should be considered for these patients.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
2014 年，在英格兰和威尔士进行了超过 75000 例全髋关节置换术，预计这一数字还会增加。本研究旨在评估 2005 年至 2014 年全髋关节置换术后的死亡率和并发症趋势，以量化风险并确定“高危”人群，从而为患者护理提供更好的建议。
我们的主要分析使用 2005 年至 2014 年的医院入院统计数据，估计全髋关节置换术后 90 天的住院死亡率。次要分析探讨了 30 天内下呼吸道感染、肾衰竭、心肌梗死、肺栓塞、深静脉血栓形成、脑血管意外和艰难梭菌感染的发生率。使用分层逻辑回归估计人群平均值，并根据时间和预后协变量进行调整。
2005 年 1 月至 2014 年 7 月，共报告了 540623 例全髋关节置换术。90 天死亡率稳步下降，从 2005 年的 0.60%下降到 2014 年的 0.15%。尽管平均 Charlson 合并症指数评分稳步上升，但报告的术后并发症（下呼吸道感染和肾衰竭除外）逐年减少。下呼吸道感染和肾衰竭的 30 天发生率分别从 0.54%上升至 0.84%和从 0.21%上升至 1.09%。与发生肺栓塞（比值比 [OR] = 10.9）或深静脉血栓形成（OR = 2.6）相比，发生下呼吸道感染（OR = 42.3）或肾衰竭（OR = 36.5）的患者死亡风险显著更高。
尽管患者的合并症水平不断上升，但 2005 年至 2014 年期间，除下呼吸道感染和肾衰竭的发生率外，医疗质量的各项指标都有所改善。术后护理应重点降低下呼吸道感染和肾衰竭的风险，这两种感染的发生率都有所增加，且与死亡率密切相关。此外，它们似乎发生在可识别的高危人群中；应考虑针对这些患者修改常规护理。
治疗性 IV 级。有关证据等级的完整描述，请参见作者说明。
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