Medicine Service, VA Medical Center, Faculty Office Tower 805B, University of Alabama, 510, 20th street South, FOT 805B, Birmingham, AL, 35233, USA.
Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Clin Rheumatol. 2020 Mar;39(3):823-830. doi: 10.1007/s10067-019-04877-8. Epub 2020 Jan 2.
To assess whether polymyositis is associated with more complications and higher healthcare utilization after total knee or hip arthroplasty (TKA/THA). Using the 1998-2014 U.S. National Inpatient Sample data, we performed multivariable-adjusted logistic regression analyses to assess the association of polymyositis with in-hospital complications (implant infection, revision, transfusion, mortality) and healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), controlling for important covariates and confounders. Sensitivity analyses additionally adjusted the main models for hospital location/teaching status, bed size, and region. Of the 4,116,485 THAs and 8,127,282 TKAs, 853 people with polymyositis had THAs (0.02%) and 1038 had TKAs (0.01%). In multivariable-adjusted analyses, compared to people without polymyositis, people with polymyositis had similar odds of hospital charges above the median, hospital stay > 3 days, and discharge to non-home setting post-TKA and post-THA. Polymyositis was associated with significantly lower odds ratio (OR; 95% confidence interval [CI]) of revision and mortality post-THA, 0.44 (0.36, 0.55) and 0.63 (0.48, 0.84), but not post-TKA, 2.98 (0.47, 18.95) and 4.40 (0.61, 31.64), respectively. Findings from the main analyses were confirmed in the sensitivity analyses. People with polymyositis had no increase in healthcare utilization post-TKA/THA. A lower revision rate and mortality post-THA in people with polymyositis need further confirmation. Study findings should reassure the key stakeholders about the benefits of TKA/THA, including people with polymyositis.
为了评估多发性肌炎是否与全膝关节或髋关节置换术后(TKA/THA)更多并发症和更高的医疗保健利用率相关。我们使用了 1998 年至 2014 年美国国家住院患者样本数据,通过多变量调整的逻辑回归分析来评估多发性肌炎与院内并发症(植入物感染、翻修、输血、死亡率)和医疗保健利用率(医院费用、住院时间、非家庭环境出院)之间的关联,同时控制了重要的协变量和混杂因素。敏感性分析还针对医院位置/教学状态、床位大小和地区调整了主要模型。在 4116485 例 THA 和 8127282 例 TKA 中,853 例患有多发性肌炎的患者接受了 THA(0.02%),1038 例患有 TKA(0.01%)。在多变量调整分析中,与没有多发性肌炎的患者相比,患有多发性肌炎的患者在 TKA 和 THA 后,医院费用高于中位数、住院时间超过 3 天以及非家庭环境出院的可能性相似。多发性肌炎与 THA 后翻修和死亡率的比值比(OR;95%置信区间 [CI])显著降低,分别为 0.44(0.36,0.55)和 0.63(0.48,0.84),但 TKA 后则没有,分别为 2.98(0.47,18.95)和 4.40(0.61,31.64)。主要分析的结果在敏感性分析中得到了证实。多发性肌炎患者在 TKA/THA 后并没有增加医疗保健利用率。多发性肌炎患者 THA 后翻修率和死亡率较低需要进一步证实。研究结果应该让 TKA/THA 的主要利益相关者放心,包括患有多发性肌炎的患者。