Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York.
George Washington School of Medicine and Health Sciences, Washington, District of Columbia.
J Knee Surg. 2021 Feb;34(3):322-327. doi: 10.1055/s-0039-1695766. Epub 2019 Aug 30.
For patients who qualify, simultaneous bilateral total knee arthroplasty (TKA) is a viable option for the treatment of bilateral symptoms. However, the incidence of chronic obstructive pulmonary disease (COPD) has been steadily rising over the past few decades and may impact those who qualify as candidates for bilateral TKA. As such, the aim of this study was to determine the impact of COPD on postoperative outcomes in patients who receive simultaneous bilateral TKA. A retrospective cohort study was conducted utilizing data provided through the American College of Surgeons National Surgical Quality Improvement Program. All patients who had undergone simultaneous bilateral TKA between 2007 and 2016 were identified and further stratified into groups based upon the COPD status. Incidence of adverse events after TKA in the acute postoperative period was evaluated with univariate and multivariate analyses. COPD was found to be an independent risk factor for the development of major (odds ratio [OR]: 2.5; = 0.015), renal (OR: 5.1; = 0.02), and thromboembolic complications (OR: 2.5; = 0.027). In addition, patients with COPD were at increased risk for having an extended hospital length of stay (LOS; < 0.001) and development of urinary tract infections ( < 0.001). Patients with COPD are at higher risk for development of overall major complications, as well as renal and thromboembolic complications after simultaneous bilateral TKA. Interestingly, patients were not at increased risk for the development of pulmonary or wound complications. When considering a staged versus simultaneous bilateral TKA, surgeons should be aware of the impact COPD status has on the postoperative complication rate.
对于符合条件的患者，同期双侧全膝关节置换术（TKA）是治疗双侧症状的可行选择。然而，过去几十年中慢性阻塞性肺疾病（COPD）的发病率一直在稳步上升，可能会影响那些符合双侧 TKA 候选条件的患者。因此，本研究旨在确定 COPD 对接受同期双侧 TKA 的患者术后结果的影响。本研究采用美国外科医师学会国家手术质量改进计划提供的数据进行回顾性队列研究。确定了 2007 年至 2016 年间接受同期双侧 TKA 的所有患者，并根据 COPD 状况进一步分层为组。使用单变量和多变量分析评估 TKA 后急性术后期间不良事件的发生率。COPD 被发现是发生重大并发症（优势比 [OR]：2.5； = 0.015）、肾脏（OR：5.1； = 0.02）和血栓栓塞并发症（OR：2.5； = 0.027）的独立危险因素。此外，COPD 患者的住院时间延长（LOS； < 0.001）和发生尿路感染的风险增加（ < 0.001）。COPD 患者在接受同期双侧 TKA 后发生总体重大并发症以及肾脏和血栓栓塞并发症的风险更高。有趣的是，患者发生肺部或伤口并发症的风险没有增加。当考虑分期与同期双侧 TKA 时，外科医生应意识到 COPD 状况对术后并发症发生率的影响。
