Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA.
J Arthroplasty. 2021 Mar;36(3):1023-1028. doi: 10.1016/j.arth.2020.09.043. Epub 2020 Sep 28.
Iron deficiency anemia (IDA) is a medical comorbidity commonly diagnosed in those undergoing primary total hip arthroplasty (THA). The authors sought to evaluate IDA as a risk factor for early postoperative complications following discharge and describe the hospital resource utilization of this patient population.
Patients with a diagnosis of IDA who underwent THA from 2005 to 2014 were identified in a national insurance database. The rates of postoperative medical complications and surgery-related complications, as well as hospital readmission, emergency department visits, and death were calculated. Additionally, 90-day and day of surgery cost and length of stay were calculated. IDA patients were then compared to a 4:1 matched control population without IDA using a logistic regression analysis to control for confounding factors.
In total, 98,681 patients with a preoperative diagnosis of IDA who underwent THA were identified and compared to 386,724 controls. IDA was associated with increased risk of 30-day emergency department visits (odds ratio [OR] 1.35, P < .001) and 30-day readmission (OR 1.49, P < .001). IDA was also associated with an increased 90-day medical complication rate (cerebrovascular accident OR 1.11, P = .003; urinary tract infection OR 1.14, P < .001; acute renal failure OR 1.24, P < .001; transfusion OR 1.40, P < .001), as well as 1-year periprosthetic joint infection (OR 1.27, P < .001), revision (OR 1.22, P < .001), dislocation (OR 1.25, P < .001), and fracture (OR 1.43, P < .001). Patients with IDA accrued higher hospital charges ($27,658.27 vs $16,709.18, P < .001) and lower hospital reimbursement ($5509.90 vs $3605.59, P < .001).
Patients with preoperative IDA undergoing THA are at greater risk of experiencing early postoperative complications and have greater utilization of hospital resources.
缺铁性贫血（IDA）是在接受初次全髋关节置换术（THA）的患者中常见的医学合并症。作者旨在评估 IDA 是否为术后出院早期并发症的危险因素，并描述该患者人群的医院资源利用情况。
在国家保险数据库中，确定了 2005 年至 2014 年间患有 IDA 并接受 THA 的患者。计算了术后医疗并发症和手术相关并发症的发生率，以及医院再入院、急诊就诊和死亡的发生率。此外，还计算了 90 天和手术当天的费用以及住院时间。然后，通过逻辑回归分析，将 IDA 患者与无 IDA 的 4:1 匹配对照组进行比较，以控制混杂因素。
共确定了 98681 例术前诊断为 IDA 并接受 THA 的患者，并与 386724 例对照组进行比较。IDA 与 30 天内急诊就诊（优势比[OR]1.35，P<.001）和 30 天内再入院（OR1.49，P<.001）的风险增加相关。IDA 还与 90 天内医疗并发症发生率增加相关（脑血管意外 OR1.11，P=.003；尿路感染 OR1.14，P<.001；急性肾衰竭 OR1.24，P<.001；输血 OR1.40，P<.001），以及 1 年内假体周围关节感染（OR1.27，P<.001）、翻修（OR1.22，P<.001）、脱位（OR1.25，P<.001）和骨折（OR1.43，P<.001）。IDA 患者的住院费用更高（$27658.27 比 $16709.18，P<.001），而住院报销额更低（$5509.90 比 $3605.59，P<.001）。
术前患有 IDA 的接受 THA 的患者发生术后早期并发症的风险更高，并且对医院资源的利用更多。
