Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, USA.
Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Clin Rheumatol. 2020 Jan;39(1):85-92. doi: 10.1007/s10067-019-04754-4. Epub 2019 Aug 23.
To assess whether systemic sclerosis (SSc) is associated with total knee arthroplasty (TKA) outcomes.
We used the 1998-2014 US National Inpatient Sample. We conducted multivariable-adjusted logistic regression analyses to examine the association of a diagnosis of SSc with post-TKA in-hospital complications (implant infection, revision, transfusion, mortality) and healthcare utilization (hospital charges, hospital stay, non-home vs. home discharge). Odds ratios (OR) and 95 % confidence intervals (CI) were calculated.
Our cohort included 8,123,388 people without SSc and 3894 people with SSc. In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher odds of transfusion, hospital stay > 3 days and non-home discharge with higher OR of 1.42 (95 % CI, 1.20, 1.69), 1.29 (95 % CI, 1.11, 1.49), and 1.29 (95 % CI, 1.11, 1.49), respectively. No differences were seen in revision, 0.68 (95 % CI, 0.10, 4.69) or hospital charges above the median, 1.01 (95 % CI, 0.70, 1.46). Differences in implant infection or mortality were not estimable, since none of the patients with SSc had implant infection or died. Sensitivity analyses that adjusted the main analysis additionally for hospital-level variables confirmed study findings with minimal or no attenuation of OR.
SSc was associated with higher risk of transfusion and increased healthcare utilization after TKA. Future studies should examine if interventions can address modifiable factors to further optimize these outcomes.Key Points• Systemic sclerosis was independently associated with higher healthcare utilization after TKA.• The adjusted odds of transfusion was higher in people with systemic sclerosis compared to those without systemic sclerosis who underwent TKA.
评估系统性硬化症（SSc）是否与全膝关节置换术（TKA）的结果相关。
我们使用了 1998 年至 2014 年美国国家住院患者样本。我们进行了多变量调整的逻辑回归分析，以研究 SSc 诊断与 TKA 后院内并发症（植入物感染、翻修、输血、死亡率）和医疗保健利用（医院费用、住院时间、非家庭与家庭出院）之间的关联。计算了比值比（OR）和 95%置信区间（CI）。
我们的队列包括 8123388 名没有 SSc 的人和 3894 名有 SSc 的人。在多变量调整分析中，与没有 SSc 的人相比，有 SSc 的人输血、住院时间>3 天和非家庭出院的可能性更高，OR 分别为 1.42（95%CI，1.20，1.69）、1.29（95%CI，1.11，1.49）和 1.29（95%CI，1.11，1.49）。在翻修方面没有差异，0.68（95%CI，0.10，4.69）或高于中位数的医院费用，1.01（95%CI，0.70，1.46）。由于没有 SSc 患者发生植入物感染或死亡，因此无法估计感染或死亡率的差异。对主要分析进行了额外调整医院水平变量的敏感性分析证实了研究结果，OR 几乎没有或没有减弱。
SSc 与 TKA 后输血风险增加和医疗保健利用率增加相关。未来的研究应检查干预措施是否可以解决可改变的因素，以进一步优化这些结果。
SSc 与 TKA 后医疗保健利用增加独立相关。
与未接受 TKA 的 SSc 患者相比，接受 TKA 的 SSc 患者的输血调整后比值比更高。
