From the Department of Orthopaedic Surgery (Dr. Luo, Dr. Gwam, Dr. Zuskov, and Dr. Plate), Wake Forest Baptist Medical Center, Winston-Salem, NC, Department of Orthopaedic Surgery (Dr. Vakharia), Maimonides Medical Center, Brooklyn, NY, and the Holy Cross Hospital (Dr. Roche), Orthopaedic Research Institute, Ft. Lauderdale, FL.
J Am Acad Orthop Surg. 2021 Jun 15;29(12):e593-e600. doi: 10.5435/JAAOS-D-20-00466.
Several studies have found the negative impact of alcohol use disorder (AUD), most notably coagulation derangements. We sought to investigate the effects of AUD after primary total knee arthroplasty (TKA) for (1) postoperative complications, (2) lengths of stay, and (3) costs of care.
This was a retrospective database analysis of Medicare patients with AUD undergoing primary TKA performed between 2005 and 2014. Patients with AUD were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 354,690 TKA patients: 59,126 with AUD and 295,564 without AUD.
Patients with AUD had significantly greater odds ratio (OR) of medical complications, including venous thromboembolism (VTE) within 90 days (OR: 1.41, P < 0.0001) and at 1 year (OR: 1.51, P < 0.0001) and greater 2-year implant-related complications after primary TKA. Furthermore, patients with AUD had significantly longer lengths of stay (4 versus 3 days, P < 0.0001) and incurred a significantly higher episode of care costs ($15,569.76 versus $13,763.06, P < 0.0001).
The present study demonstrated a significant association between AUD and the development of VTE. We hope this research will aid in risk stratification and tailoring of VTE chemoprophylaxis and postoperative management in this at-risk group after TKA.
Level III.
多项研究发现，酒精使用障碍（AUD）会产生负面影响，最显著的是凝血功能紊乱。我们旨在调查 AUD 对初次全膝关节置换术（TKA）后（1）术后并发症、（2）住院时间和（3）医疗费用的影响。
这是一项针对 Medicare 中 AUD 患者的回顾性数据库分析，这些患者在 2005 年至 2014 年间接受了初次 TKA。通过年龄、性别和合并症对 AUD 患者与对照组进行 1:5 匹配。查询共得到 354690 例 TKA 患者：59126 例 AUD 患者和 295564 例非 AUD 患者。
AUD 患者发生医疗并发症的可能性明显更高，包括 90 天内（比值比[OR]：1.41，P<0.0001）和 1 年内（OR：1.51，P<0.0001）静脉血栓栓塞（VTE）以及初次 TKA 后 2 年内植入物相关并发症的风险更高。此外，AUD 患者的住院时间明显更长（4 天与 3 天，P<0.0001），且医疗费用明显更高（15569.76 美元与 13763.06 美元，P<0.0001）。
本研究表明 AUD 与 VTE 的发生显著相关。我们希望这项研究将有助于对 TKA 后这一高危人群进行 VTE 化学预防和术后管理的风险分层和个体化。
III 级。
