Raddaoui Khairreddine, Khedhri Wafa, Zoghlami Karima, Radhouani Mohamed, Trigui Emna, Kaabachi Olfa
Department Of Critical Care and Anaesthesiology, Kassab Orthopaedic Institute, Faculty Of Medicine Of Tunis, Tunis El Manar University, Tunisia.
Pan Afr Med J. 2019 Jul 19;33:233. doi: 10.11604/pamj.2019.33.233.19095. eCollection 2019.
As the life expectancy and weight of patients are increasing, more old and obese patients are undergoing total knee arthroplasty (TKA). TKA may lead to several perioperative complications. These include anesthesia-related risks, exacerbation of comorbid medical issues and complications of surgical procedure. We have no studies reporting medical complications following TKA among our population. This study aimed to evaluate perioperative complications of TKA and to identify the related risk factors.
It was a monocentric retrospective including 410 observations in the local TKA registry. Data of patients operated for primary unilateral TKA during the period from January 2014 to December 2017 were reviewed. All patients had standardized protocols of anesthesia and post operative care for three days following surgery. Multivariate logistic regression was used to identify the predicting factors for complications.
Incidence of perioperative complications was 37.1%. The most frequent were per operative hypotension (14.1%) and postoperative desaturation (21.7%, including pulmonary embolism in 2.4%). Multivariate logistic regression analysis identified: age ≥ 65 years (OR=1.9; p=0.006), respiratory diseases (OR=1.8; p=0.042) and general anesthesia (OR=2.8; p=0.009) as significant risk factors for any complications. Loss of autonomy (OR=4.8; p <0.001) and general anesthesia (OR=2.6; p=0.03) were significant risk factors for hypotension. Age ≥ 65 years (OR=2.6;p<0.001), female gender (OR=4.3;p=0.006) and respiratory diseases(OR=1.9;p=0.02) were associated with postoperative desaturation.
This study highlighted hemodynamic and respiratory complications as the most common early complications in TKA. Age ≥ 65years, general anesthesia and respiratory diseases were significant risk factors.
随着患者预期寿命和体重的增加，越来越多的老年肥胖患者正在接受全膝关节置换术（TKA）。TKA可能导致多种围手术期并发症。这些并发症包括与麻醉相关的风险、合并症的加重以及手术操作的并发症。在我们的人群中，尚无关于TKA术后医疗并发症的研究报告。本研究旨在评估TKA的围手术期并发症并确定相关危险因素。
这是一项单中心回顾性研究，纳入了当地TKA登记处的410例观察病例。对2014年1月至2017年12月期间接受初次单侧TKA手术的患者数据进行了回顾。所有患者在术后三天均采用标准化的麻醉和术后护理方案。采用多因素逻辑回归分析来确定并发症的预测因素。
围手术期并发症的发生率为37.1%。最常见的是术中低血压（14.1%）和术后低氧血症（21.7%，包括2.4%的肺栓塞）。多因素逻辑回归分析确定：年龄≥65岁（OR=1.9；p=0.006）、呼吸系统疾病（OR=1.8；p=0.042）和全身麻醉（OR=2.8；p=0.009）是任何并发症的显著危险因素。自主能力丧失（OR=4.8；p<0.001）和全身麻醉（OR=2.6；p=0.03）是低血压的显著危险因素。年龄≥65岁（OR=2.6；p<0.001）、女性（OR=4.3；p=0.006）和呼吸系统疾病（OR=1.9；p=0.02）与术后低氧血症相关。
本研究强调血流动力学和呼吸系统并发症是TKA最常见的早期并发症。年龄≥65岁、全身麻醉和呼吸系统疾病是显著的危险因素。
