Curtis Gannon L, Chughtai Morad, Khlopas Anton, Newman Jared M, Sultan Assem A, Sodhi Nipun, Barsoum Wael K, Higuera Carlos A, Mont Michael A
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Orthopaedic Surgery,SUNY Downstate Medical Center, Brooklyn, New York.
Surg Technol Int. 2018 Jun 1;32:263-269.
Although there are studies regarding immunosuppressed patients undergoing total knee arthroplasty (TKA) for inflammatory arthritis or osteonecrosis, there is a paucity of studies evaluating immunosuppressed patients undergoing TKA for diagnoses other than these.
We identified all patients undergoing primary TKA for osteoarthritis from 2008-2014 in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Overall, 111,624 patients were included. The immunosuppressed group consisted of 3,466 patients, and the control group included 108,158. Outcomes measured included operative time, lengths-of-stay, discharge destination, and 30-day complication rates. Univariate analysis was used to compare the outcomes. Multivariate regression analysis was then applied to determine if immunosuppression was an independent risk factor for differences in outcomes.
Immunosuppressant use did not change operative time, lengths-of-stay, or discharge disposition. Immunosuppressed patients were at higher risks of developing the following surgical and medical complications: organ/space surgical site infection (SSI), wound dehiscence, deep venous thrombosis (DVT), pneumonia, urinary tract infection (UTI), and systemic sepsis. Return to the operating room and 30-day readmission were also significantly higher in the immunosuppressed group.
Patients taking chronic immunosuppressants and undergoing TKA for osteoarthritis are at higher risk of specific surgical and medical complications. These complications include organ/space SSI, wound dehiscence, DVT, pneumonia, UTI, and systemic sepsis. In addition, these patients were at increased odds of returning to the operating room and being readmitted.
尽管有关于因炎性关节炎或骨坏死接受全膝关节置换术（TKA）的免疫抑制患者的研究，但对于因这些以外的诊断接受TKA的免疫抑制患者，评估的研究较少。
我们在美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库中确定了2008年至2014年因骨关节炎接受初次TKA的所有患者。总体而言，纳入了111,624例患者。免疫抑制组由3466例患者组成，对照组包括108,158例。测量的结果包括手术时间、住院时间、出院目的地和30天并发症发生率。采用单因素分析比较结果。然后应用多因素回归分析来确定免疫抑制是否是结果差异的独立危险因素。
使用免疫抑制剂并未改变手术时间、住院时间或出院处置。免疫抑制患者发生以下手术和医疗并发症的风险更高：器官/腔隙手术部位感染（SSI）、伤口裂开、深静脉血栓形成（DVT）、肺炎、尿路感染（UTI）和全身性脓毒症。免疫抑制组返回手术室和30天再入院的比例也显著更高。
服用慢性免疫抑制剂并因骨关节炎接受TKA的患者发生特定手术和医疗并发症的风险更高。这些并发症包括器官/腔隙SSI、伤口裂开、DVT、肺炎、UTI和全身性脓毒症。此外，这些患者返回手术室和再次入院的几率增加。
