Hegde Vishal, Arshi Armin, Wang Christopher, Buser Zorica, Wang Jeffrey C, Jensen Andrew R, Adams John S, Zeegen Erik N, Bernthal Nicholas M
Orthopedics. 2018 Jul 1;41(4):e489-e495. doi: 10.3928/01477447-20180424-04. Epub 2018 Apr 30.
The purpose of this study was to determine the relative incidence of postoperative complications in 25-hydroxyvitamin D (25D)-deficient and -sufficient patients undergoing total knee arthroplasty (TKA). Patients who were either serum 25D deficient (25D <20 ng/mL) or 25D sufficient (25D ≥20 ng/mL) 90 days prior to primary TKA from 2007 to 2016 were identified using the Humana administrative claims registry. The incidence of postoperative medical and surgical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Risk-adjusted odds ratios (ORs) were calculated using multivariate logistic regression with age, sex, and Charlson Comorbidity Index as covariates. In total, 868 of 6593 patients who underwent TKA from 2007 to 2016 were 25D deficient, corresponding to a 13.2% prevalence rate. On adjustment for age, sex, and Charlson Comorbidity Index, 25D-deficient patients had a higher incidence of postoperative stiffness requiring manipulation under anesthesia (OR, 1.69; 95% confidence interval [CI], 1.39-2.04; P<.001), surgical site infection requiring irrigation and debridement (OR, 1.76; 95% CI, 1.25-2.48; P=.001), and prosthesis explantation (OR, 2.97; 95% CI, 2.04-4.31; P<.001) at 1 year. Patients who were 25D deficient also had higher rates of postoperative deep venous thrombosis (OR, 1.80; 95% CI, 1.36-2.38; P<.001), myocardial infarction (OR, 2.11; 95% CI, 1.41-3.15; P<.001), and cerebrovascular accident (OR, 1.73; 95% CI, 1.17-2.57; P=.006). Thus, serum 25D levels below 20 ng/mL are associated with a higher incidence of postoperative complications and may be a perioperative modifiable risk factor in TKA. [Orthopedics. 2018; 41(4):e489-e495.].
本研究的目的是确定接受全膝关节置换术（TKA）的25-羟基维生素D（25D）缺乏和充足患者术后并发症的相对发生率。利用Humana行政索赔登记处确定了2007年至2016年初次TKA术前90天血清25D缺乏（25D<20 ng/mL）或25D充足（25D≥20 ng/mL）的患者。通过查询相关的国际疾病分类第九版和当前程序术语代码来确定术后内科和外科并发症的发生率。以年龄、性别和Charlson合并症指数作为协变量，使用多变量逻辑回归计算风险调整后的比值比（OR）。2007年至2016年接受TKA的6593例患者中，共有868例25D缺乏，患病率为13.2%。在对年龄、性别和Charlson合并症指数进行调整后，25D缺乏的患者术后需要在麻醉下进行手法治疗的僵硬发生率更高（OR，1.69；95%置信区间[CI]，1.39-2.04；P<.001），需要冲洗和清创的手术部位感染发生率更高（OR，1.76；95%CI，1.25-2.48；P=.001），以及1年后假体取出率更高（OR，2.97；95%CI，2.04-4.31；P<.001）。25D缺乏的患者术后深静脉血栓形成率（OR，1.80；95%CI，1.36-2.38；P<.001）、心肌梗死率（OR，2.11；95%CI，1.41-3.15；P<.001）和脑血管意外率（OR，1.73；95%CI，1.17-2.57；P=.006）也更高。因此，血清25D水平低于20 ng/mL与术后并发症的较高发生率相关，可能是TKA围手术期一个可改变的危险因素。[《骨科学》。2018；41(4):e489-e495。]
