Medicine Service, Birmingham Veterans Affairs (VA) Medical Center, 700 19th St S, Birmingham, 35233, AL, United States.
Department of Medicine at the School of Medicine, University of Alabama at Birmingham, 510 20th Street South, Birmingham, 35294, AL, United States.
Clin Rheumatol. 2020 Aug;39(8):2345-2353. doi: 10.1007/s10067-020-05036-0. Epub 2020 Mar 14.
Our objective was to assess healthcare utilization and complication rates after primary total knee/hip arthroplasty (TKA/THA) in people with spondyloarthritis (SpA) compared with people without SpA. We performed multivariable-adjusted logistic regression using the 1998-2014 US National Inpatient Sample (NIS), adjusted for age, race/ethnicity, gender, income, Deyo-Charlson comorbidity index, insurance payer, and the underlying diagnosis. The primary THA cohort consisted of 4,116,484 THAs (1.7% with SpA) and primary TKA cohort of 8,127,282 TKAs (1% with SpA). Compared with people without SpA, people with SpA had higher odds ratio (OR (95% confidence interval (CI)) of the following post-THA and post-TKA, respectively: (1) discharge to care facility, 1.16 (1.12, 1.21) and 1.14 (1.11, 1.18); (2) hospital stay > 3 days, 1.15 (1.11, 1.20) and 1.05 (1.01, 1.10); and (3) transfusion, 1.16 (1.12, 1.21) and 1.10 (1.05, 1.14); but lower odds of (1) mortality, 0.78 (0.64, 0.96) and 0.40 (0.19, 0.84); and (2) hospital charges above the median, 0.49 (0.46, 0.53) and 0.48 (0.45, 0.51). SpA was associated with higher odds of implant infection, 3.02 (2.27, 4.03) post-TKA, not post-THA. In-hospital revision rate did not differ. People with SpA utilize more healthcare services and have more complications post-THA/TKA. Interventions to reduce complications and associated utilization are needed. Key Points • People with spondyloarthritis utilized more healthcare services and had a higher risk of transfusion post-THA/TKA, compared with people without spondyloarthritis. • Spondyloarthritis was associated with lower in-hospital mortality rates after THA/TKA. • Spondyloarthritis was associated with a higher risk of implant infection after TKA, but not THA. • A pre-operative discussion with people with spondyloarthritis of possibly higher implant infection after TKA could lead to a more informed consent.
我们的目的是评估原发性全膝关节/髋关节置换术（TKA/THA）后脊柱关节炎（SpA）患者与非 SpA 患者的医疗保健利用和并发症发生率。我们使用 1998-2014 年美国国家住院患者样本（NIS）进行了多变量调整的逻辑回归，调整了年龄、种族/民族、性别、收入、Deyo-Charlson 合并症指数、保险支付者和潜在诊断。主要的 THA 队列包括 4116484 例 THA（1.7%患有 SpA）和 8127282 例 TKA（1%患有 SpA）。与非 SpA 患者相比，SpA 患者在以下 TKA 和 TKA 术后具有更高的优势比（OR（95%置信区间（CI））：（1）出院到护理机构，1.16（1.12，1.21）和 1.14（1.11，1.18）；（2）住院时间>3 天，1.15（1.11，1.20）和 1.05（1.01，1.10）；（3）输血，1.16（1.12，1.21）和 1.10（1.05，1.14）；但（1）死亡率较低，0.78（0.64，0.96）和 0.40（0.19，0.84）；（2）住院费用高于中位数，0.49（0.46，0.53）和 0.48（0.45，0.51）。SpA 与 TKA 术后而非 THA 术后的更高的植入物感染几率相关，OR 为 3.02（2.27，4.03）。住院期间的翻修率没有差异。SpA 患者在 TKA/THA 后需要更多的医疗服务和更多的并发症。需要采取干预措施来减少并发症和相关的利用。关键点•与非 SpA 患者相比，SpA 患者在 TKA/THA 后利用了更多的医疗服务，并且输血的风险更高。•THA/TKA 后，SpA 与较低的院内死亡率相关。•SpA 与 TKA 后较高的植入物感染风险相关，但与 THA 无关。•与 SpA 患者术前讨论 TKA 后可能更高的植入物感染风险，可以使患者获得更充分的知情同意。
