Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Clin Orthop Surg. 2020 Mar;12(1):37-42. doi: 10.4055/cios.2020.12.1.37. Epub 2020 Feb 13.
The number of patients with systemic lupus erythematosus (herein, lupus) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is increasing. There is disagreement about the effect of lupus on perioperative complication rates. We hypothesized that lupus would be associated with higher complication rates in patients who undergo elective primary THA or TKA.
Records of more than 6.2 million patients from the National Inpatient Sample who underwent elective primary THA or TKA from 2000 to 2009 were reviewed. Patients with lupus (n = 38,644) were compared with those without lupus (n = 6,173,826). Major complications were death, pulmonary embolism, myocardial infarction, stroke, pneumonia, and acute renal failure. Minor complications were wound infection, seroma, deep vein thrombosis, hip dislocation, wound dehiscence, and hematoma. Patient age, sex, duration of hospital stay, and number of Elixhauser comorbidities were assessed for both groups. Multivariate logistic regression models using comorbidities, age, and sex as covariates were used to assess the association of lupus with major and minor perioperative complications. The alpha level was set to 0.001.
Among patients who underwent THA, those with lupus were younger (mean age, 56 vs. 65 years), were more likely to be women (87% vs. 56%), had longer hospital stays (mean, 4.0 vs. 3.8 days), and had more comorbidities (mean, 2.5 vs. 1.4) than those without lupus (all < 0.001). In patients with THA, lupus was independently associated with major complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and minor complications (OR, 1.2; 95% CI, 1.0 to 1.5). Similarly, among patients who underwent TKA, those with lupus were younger (mean, 62 vs. 67 years), were more likely to be women (93% vs. 64%), had longer hospital stays (mean, 3.8 vs. 3.7 days), and had more comorbidities (mean, 2.8 vs. 1.7) than those without lupus (all < 0.001). However, in TKA patients, lupus was not associated with greater odds of major complications (OR, 1.2; 95% CI, 0.9 to 1.4) or minor complications (OR, 1.1; 95% CI, 0.9 to 1.3).
Lupus is an independent risk factor for major and minor perioperative complications in elective primary THA but not TKA.
患有系统性红斑狼疮（下文简称狼疮）的患者行全髋关节置换术（THA）或全膝关节置换术（TKA）的人数正在增加。狼疮对围手术期并发症发生率的影响存在争议。我们假设狼疮与接受择期初次 THA 或 TKA 的患者的更高并发症发生率相关。
对 2000 年至 2009 年期间，在全国住院患者样本中接受择期初次 THA 或 TKA 的 620 多万例患者的记录进行了回顾。将狼疮患者（n=38644）与无狼疮患者（n=6173826）进行了比较。主要并发症包括死亡、肺栓塞、心肌梗死、中风、肺炎和急性肾衰竭。次要并发症包括伤口感染、血清肿、深静脉血栓形成、髋关节脱位、伤口裂开和血肿。评估了两组患者的年龄、性别、住院时间和 Elixhauser 合并症数量。使用合并症、年龄和性别作为协变量的多变量逻辑回归模型用于评估狼疮与主要和次要围手术期并发症的关系。设定α水平为 0.001。
在接受 THA 的患者中，狼疮患者更年轻（平均年龄，56 岁 vs. 65 岁），更可能为女性（87% vs. 56%），住院时间更长（平均，4.0 天 vs. 3.8 天），合并症更多（平均，2.5 个 vs. 1.4 个）（均 P<0.001）。在接受 THA 的患者中，狼疮与主要并发症（比值比[OR]，1.4；95%置信区间[CI]，1.1 至 1.7）和次要并发症（OR，1.2；95% CI，1.0 至 1.5）独立相关。同样，在接受 TKA 的患者中，狼疮患者更年轻（平均年龄，62 岁 vs. 67 岁），更可能为女性（93% vs. 64%），住院时间更长（平均 3.8 天 vs. 3.7 天），合并症更多（平均 2.8 个 vs. 1.7 个）（均 P<0.001）。然而，在 TKA 患者中，狼疮与更高的主要并发症（OR，1.2；95% CI，0.9 至 1.4）或次要并发症（OR，1.1；95% CI，0.9 至 1.3）无关。
狼疮是择期初次 THA 而不是 TKA 的主要和次要围手术期并发症的独立危险因素。
