全膝关节置换术后的死亡率：发生率、时间趋势和危险因素的系统评价。

Mortality After Total Knee Arthroplasty: A Systematic Review of Incidence, Temporal Trends, and Risk Factors.

机构信息

Musculoskeletal Research Unit, Translational Health Sciences: Bristol Medical School, University of Bristol, Bristol, United Kingdom.

Population Health Sciences: Bristol Medical School, Bristol, United Kingdom.

出版信息

J Bone Joint Surg Am. 2018 Jun 20;100(12):1064-1070. doi: 10.2106/JBJS.17.00249.

DOI:10.2106/JBJS.17.00249

PMID:29916935

Abstract

BACKGROUND

The capacity for total knee arthroplasty to improve pain, quality of life, and functional outcomes is widely recognized. Postoperative mortality is rare but of paramount importance, and needs to be accurately quantified and conveyed to patients in order to support decision-making prior to surgery. The purpose of this study was to determine a contemporary estimate of the risk of mortality following total knee arthroplasty, including the identification of temporal trends, common causes, and modifiable and nonmodifiable risk factors.

METHODS

We performed a systematic review with searches of MEDLINE, AMED, CAB Abstracts, and Embase. Studies in any language published from 2006 to 2016 reporting 30 or 90-day mortality following total knee arthroplasty were included, supplemented by contact with authors. Meta-analysis and meta-regression were performed for quantitative data.

RESULTS

Thirty-seven studies with mortality data from 15 different countries following over 1.75 million total knee arthroplasties formed the basis of this review. The pooled Poisson-normal random-effects meta-analysis estimates of 30 and 90-day mortality were 0.20% (95% confidence interval [CI], 0.17% to 0.24%) and 0.39% (95% CI, 0.32% to 0.49%). Both estimates have fallen over the 10-year study period (p < 0.001). Meta-regression using the median year of surgery as a moderator showed that 30 and 90-day mortality following total knee arthroplasty fell to 0.10% (95% CI, 0.07% to 0.14%) and 0.19% (95% CI, 0.15% to 0.23%), respectively, in 2015. The leading cause of death was cardiovascular disease.

CONCLUSIONS

There is an ongoing worldwide temporal decline in mortality following total knee arthroplasty. Improved patient selection and perioperative care and a healthy-population effect may account for this observation. Efforts to further reduce mortality should be targeted primarily at reducing cardiovascular events following total knee arthroplasty.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

全膝关节置换术改善疼痛、生活质量和功能结果的能力已得到广泛认可。术后死亡率罕见，但至关重要，需要准确量化并向患者传达，以支持手术前的决策。本研究的目的是确定全膝关节置换术后死亡率的当代估计值，包括确定时间趋势、常见原因以及可改变和不可改变的危险因素。

方法

我们进行了系统评价，检索了 MEDLINE、AMED、CAB 摘要和 Embase。纳入了 2006 年至 2016 年期间以任何语言发表的报告全膝关节置换术后 30 天或 90 天死亡率的研究，并通过与作者联系进行了补充。对定量数据进行了荟萃分析和荟萃回归。

结果

这项综述的基础是来自 15 个不同国家的 37 项研究，这些研究报告了超过 175 万例全膝关节置换术后的死亡率数据。汇总泊松正态随机效应荟萃分析估计 30 天和 90 天的死亡率分别为 0.20%（95%置信区间，0.17%至 0.24%）和 0.39%（95%置信区间，0.32%至 0.49%）。这两个估计值在 10 年的研究期间都有所下降（p < 0.001）。使用中位数手术年份作为调节因素的荟萃回归显示，全膝关节置换术后 30 天和 90 天的死亡率分别降至 0.10%（95%置信区间，0.07%至 0.14%）和 0.19%（95%置信区间，0.15%至 0.23%），分别为 2015 年。死亡的主要原因是心血管疾病。