术前贫血独立预测无菌性髋关节和膝关节翻修术后近期并发症的风险显著增加。

Preoperative Anemia Independently Predicts Significantly Increased Odds of Short-Term Complications Following Aseptic Revision Hip and Knee Arthroplasty.

机构信息

Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC; Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY.

Weill Cornell Medical College, New York, NY.

出版信息

J Arthroplasty. 2021 May;36(5):1719-1728. doi: 10.1016/j.arth.2020.10.061. Epub 2020 Nov 7.

DOI:10.1016/j.arth.2020.10.061

PMID:33248920

Abstract

BACKGROUND

Preoperative anemia is an important risk factor for developing complications following revision hip (rTHA) and knee (rTKA) arthroplasty. We aim to determine the effect of anemia severity on 30-day postoperative complications following revision hip and knee arthroplasty.

METHODS

A retrospective cohort study was conducted using the American College of Surgeons National Quality Improvement Program Database. All patients who underwent revision joint arthroplasty (rTJA) between 2006 to 2017 were identified and grouped based upon the hematocrit (Hct) level. Anemia was defined as Hct <36% for women and <39% for men, and further stratified into mild anemia (Hct 33% to 36% for women, Hct 33% to 39% for men), and moderate to severe anemia (Hct <33% for both men and women). Univariate and multivariate analysis were used to evaluate the incidence of multiple adverse events within 30 days after TJA.

RESULTS

A total of 8932 patients undergoing rTHA and 13,313 patients undergoing rTKA were included for analysis. On multivariate adjustment, patients undergoing rTHA with moderate to severe anemia had an increased odds of 5.437 (95% Confidence Interval (CI) 4.604 to 6.421; P < .001) of developing any postoperative complication. On multivariate adjustment, patients undergoing rTKA with moderate to severe anemia had increased odds of 6.731 (95% Confidence Interval (CI) 5.540 to 8.179; P < .001) of developing any postoperative complication.

CONCLUSION

The increasing severity of anemia was associated with an increasing risk of developing any postoperative complication and death following revision hip and knee arthroplasty. There is a significant trend between diminishing preoperative hematocrit levels and increasing odds of postoperative complication.

摘要

背景

术前贫血是髋关节翻修术（rTHA）和膝关节翻修术（rTKA）后发生并发症的重要危险因素。本研究旨在确定贫血严重程度对髋关节和膝关节翻修术后 30 天内术后并发症的影响。

方法

本研究采用美国外科医师学会国家质量改进计划数据库进行回顾性队列研究。2006 年至 2017 年间，所有接受关节翻修术（rTJA）的患者均根据血细胞比容（Hct）水平进行分组。贫血定义为女性 Hct<36%，男性 Hct<39%，并进一步分为轻度贫血（女性 Hct 为 33%至 36%，男性 Hct 为 33%至 39%）和中重度贫血（男女 Hct 均<33%）。采用单变量和多变量分析评估 TJA 后 30 天内多种不良事件的发生率。

结果

共纳入 8932 例接受 rTHA 和 13313 例接受 rTKA 的患者进行分析。多变量调整后，中重度贫血的 rTHA 患者发生任何术后并发症的风险增加 5.437 倍（95%置信区间[CI]为 4.604 至 6.421；P<0.001）。多变量调整后，中重度贫血的 rTKA 患者发生任何术后并发症的风险增加 6.731 倍（95%CI 为 5.540 至 8.179；P<0.001）。