Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Orthopaedic Department, Faculty of Medicine, Khon Kaen University, Thailand.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2020 Jul;35(7):1937-1940. doi: 10.1016/j.arth.2020.03.003. Epub 2020 Mar 6.
Despite improved surgical and anesthesia techniques, as well as advances in perioperative protocols, a number of patients undergoing total joint arthroplasty (TJA) are at risk of serious medical complications that require intensive care unit (ICU) admission. With the recent move toward performing TJA in ambulatory surgical centers and on an outpatient basis, it is important to recognize patients that may require intensive care in the postoperative period. This study aimed to identify risk factors for ICU admission following elective total hip (THA) and knee (TKA) arthroplasty.
We evaluated 12,342 THA procedures, with 132 ICU admissions, and 10,976 TKA procedures, with 114 ICU admissions from 2005 to 2017. Demographic, preoperative, and surgical variables were collected and compared between cohorts using both univariate and logistic regression analysis.
For THA, logistic regression analysis demonstrated older age, bilateral procedure, revision surgery, increased Charlson comorbidity index, general anesthesia, increased estimated blood loss, decreased preoperative hemoglobin, and increased preoperative glucose level were independently associated factors for increased risk of ICU admission. For TKA, increased age, increased body mass index, bilateral procedure, revision surgery, increased Charlson comorbidity index, increased estimated blood loss, general anesthesia, and increased preoperative glucose were independently significantly associated with ICU admission.
In this study, we identify a number of critical independent risk factors which may place patients at increased risk of ICU admission following THA and TKA. Identification of these risk factors may help surgeons safely select those TJA candidates appropriate for surgery at facilities that do not have ICUs readily available.
尽管手术和麻醉技术有所提高，围手术期方案也有所改进，但仍有许多接受全关节置换术（TJA）的患者存在严重的医疗并发症风险，需要入住重症监护病房（ICU）。随着最近在日间手术中心和门诊进行 TJA 的趋势，重要的是要认识到可能在术后需要重症监护的患者。本研究旨在确定择期全髋关节置换术（THA）和全膝关节置换术（TKA）后入住 ICU 的危险因素。
我们评估了 2005 年至 2017 年期间的 12342 例 THA 手术，其中有 132 例 ICU 入院，10976 例 TKA 手术，其中有 114 例 ICU 入院。使用单变量和逻辑回归分析收集并比较了两组之间的人口统计学、术前和手术变量。
对于 THA，逻辑回归分析表明，年龄较大、双侧手术、翻修手术、Charlson 合并症指数增加、全身麻醉、估计失血量增加、术前血红蛋白降低和术前血糖水平升高是 ICU 入院风险增加的独立相关因素。对于 TKA，年龄增加、体重指数增加、双侧手术、翻修手术、Charlson 合并症指数增加、估计失血量增加、全身麻醉和术前血糖升高与 ICU 入院显著相关。
在这项研究中，我们确定了一些关键的独立危险因素，这些危险因素可能会增加患者接受 THA 和 TKA 后入住 ICU 的风险。识别这些危险因素可能有助于外科医生安全地选择那些在没有 ICU 的情况下进行手术的 TJA 候选者。
