Knapp Brock M, Botros Mina, Sing David C, Curry Emily J, Eichinger Josef K, Li Xinning
Boston University School of Medicine, Boston, MA, USA.
Meharry Medical College, Nashville, TN, USA.
JSES Int. 2020 Feb 29;4(1):95-99. doi: 10.1016/j.jseint.2019.11.007. eCollection 2020 Mar.
Shoulder arthroplasty (SA) procedures are increasingly performed in the United States. However, there is a lack of data evaluating how patient sex may affect perioperative complications. The purpose of this study was to evaluate sex-based differences in 30-day postoperative complication and readmission rates after SA.
Total SA and reverse SA cases between 2012-2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. The 30-day complication rate, readmission rate, operation time, length of stay, and mortality were compared between women and men. Multivariable logistic regression analysis was performed to identify independent perioperative complications associated with patient sex.
Of 12,530 SA cases, 6949 (55.4%) were female and 5499 (44.5%) were male. Compared with women, on average men were significantly younger, had lower body mass index, and were less likely to be functionally dependent, and less likely to have an American Society of Anesthesiologists score of 3+ ( < .001). Although overall complications and readmission rates between women and men were similar (3.4% vs. 3.7%, = .489; 3.0% vs. 2.8%, = .497), men were significantly less likely to develop urinary tract infections (UTIs; odds ratio [OR] 0.58, = .032) and require transfusions (OR 0.49, < .001) and had shorter lengths of stay ( < .001). However, men were significantly more likely to have a superficial surgical site infection (OR 2.63, = .035) and 6.8 minute longer operating time ( < .001) compared with women.
Though the overall complication risk is similar between the sexes, their risk profiles are distinct. Men had decreased risk of UTI, blood transfusions, and shorter length of stay but increased risk of surgical site and longer operating time compared with women. This disparity should be discussed when counseling and risk-stratifying patients for SA.
在美国，肩关节置换术（SA）的实施越来越多。然而，缺乏评估患者性别如何影响围手术期并发症的数据。本研究的目的是评估SA术后30天并发症和再入院率的性别差异。
从美国外科医师学会国家外科质量改进计划数据库中识别出2012年至2016年期间的全肩关节置换术和反式肩关节置换术病例。比较了女性和男性之间的30天并发症发生率、再入院率、手术时间、住院时间和死亡率。进行多变量逻辑回归分析以确定与患者性别相关的独立围手术期并发症。
在12530例SA病例中，6949例（55.4%）为女性，5499例（44.5%）为男性。与女性相比，男性平均年龄显著更小，体重指数更低，功能依赖的可能性更小，美国麻醉医师协会评分为3+的可能性更小（P<0.001）。尽管女性和男性之间的总体并发症和再入院率相似（3.4%对3.7%，P = 0.489；3.0%对2.8%，P = 0.497），但男性发生尿路感染（UTI）的可能性显著更低（优势比[OR]0.58，P = 0.032），需要输血的可能性更低（OR 0.49，P<0.001），住院时间更短（P<0.001）。然而，与女性相比，男性发生浅表手术部位感染的可能性显著更高（OR 2.63，P = 0.035），手术时间长6.8分钟（P<0.001）。
尽管两性之间的总体并发症风险相似，但他们的风险特征不同。与女性相比，男性发生UTI、输血的风险降低，住院时间更短，但手术部位风险增加，手术时间更长。在为SA患者提供咨询和进行风险分层时，应讨论这种差异。
