Department of Orthopaedics, Southern Medical University, Guangzhou, China.
First Clinical Medical School, Southern Medical University, Guangzhou, China.
Orthop Surg. 2021 Apr;13(2):442-450. doi: 10.1111/os.12901. Epub 2021 Jan 19.
To analyze perioperative complications, resource consumption, and inpatient mortality of patients who receive total joint arthroplasty (TJA) with a concomitant diagnosis of a primary hypercoagulable state (PHS). The following questions were posed in the present paper. First, do patients undergoing TJA with PHS have increased risk of deep venous thrombosis (DVT), pulmonary embolism (PE), and periprosthetic joint infection (PJI)? Second, what other in-hospital complications are more likely among PHS patients undergoing TJA? Third, do TJA patients with PHS usually consume greater in-hospital resources? Fourth, do PHS patients suffer higher mortality rates compared to non-PHS patients? Finally, have PHS patients received proper anticoagulant management in past arthroplasties?
The National Inpatient Sample (NIS) database for the years between 2003 and 2014 was searched to identify patients undergoing primary TJA. Patients with PHS were identified with the ICD-9-CM code 289.81. The χ -test, the Pearson test, and adjusted multivariate regression analysis were performed to evaluate the difference and odds ratios between the positive and negative diagnosis groups.
From 2003 to 2014, a total of 2,044,356 patients were identified in the NIS as undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) in the United States. A total of 4664 patients (0.2%) were identified as having PHS. Compared with the non-PHS group, TJA patients with PHS had a higher risk of DVT (THA: odds ratio [OR] = 8.343, 95% CI: 5.362-12.982, P < 0.001; TKA: OR = 4.712, 95% CI: 3.560-6.238, P < 0.001) but did not have increased risk of PE (THA: OR = 1.306, 95% CI: 0.48-3.555, P = 0.602; TKA: OR = 1.143, 95% CI: 0.687-1.903), and only PHS patients in the THA group had higher risks of inpatient mortality (OR = 3.184, 95% CI: 1.348-7.522, P = 0.008) and periprosthetic joint infection (OR = 3.343, 95% CI: 1.084-10.879, P = 0.036). In addition, PHS patients had extended length of stay, higher total costs, and increased risks of certain other complications, such as peripheral vascular disease, hemorrhage, and thrombophlebitis.
In the present study, PHS patients had higher risks of DVT, greater in-hospital resource consumption, and certain other perioperative complications. However, PHS was not associated with increased risk of PE in TJA patients in the United States between 2003 and 2014. While potential hazards of PHS have already been recognized, the present study revealed additional concerns and demonstrated that further improvements in the perioperative management of patients with hereditary hypercoagulable disorders are essential.
分析同时患有原发性高凝状态（PHS）的患者在接受全关节置换术（TJA）后的围手术期并发症、资源消耗和住院死亡率。本文提出了以下问题。首先，患有 PHS 的 TJA 患者深静脉血栓形成（DVT）、肺栓塞（PE）和假体周围关节感染（PJI）的风险是否增加？其次，PHS 患者在 TJA 术后更有可能出现哪些其他院内并发症？第三，PHS 患者通常会消耗更多的院内资源吗？第四，PHS 患者的死亡率是否高于非 PHS 患者？最后，PHS 患者在过去的关节置换术中是否接受了适当的抗凝管理？
检索了 2003 年至 2014 年期间国家住院患者样本（NIS）数据库，以确定接受初次 TJA 的患者。使用 ICD-9-CM 代码 289.81 识别患有 PHS 的患者。使用 χ 2 检验、Pearson 检验和调整后的多变量回归分析来评估阳性和阴性诊断组之间的差异和优势比。
2003 年至 2014 年期间，NIS 共确定了 2044356 例在美国接受初次全髋关节置换术（THA）或全膝关节置换术（TKA）的患者。共确定了 4664 例（0.2%）患有 PHS 的患者。与非 PHS 组相比，患有 PHS 的 TJA 患者发生 DVT 的风险更高（THA：比值比[OR] = 8.343，95%CI：5.362-12.982，P<0.001；TKA：OR = 4.712，95%CI：3.560-6.238，P<0.001），但发生 PE 的风险没有增加（THA：OR = 1.306，95%CI：0.48-3.555，P = 0.602；TKA：OR = 1.143，95%CI：0.687-1.903），只有 THA 组的 PHS 患者住院死亡率（OR = 3.184，95%CI：1.348-7.522，P = 0.008）和假体周围关节感染（OR = 3.343，95%CI：1.084-10.879，P = 0.036）的风险更高。此外，PHS 患者的住院时间延长，总费用增加，并且存在某些其他并发症的风险增加，如周围血管疾病、出血和血栓性静脉炎。
在本研究中，PHS 患者发生 DVT 的风险较高，院内资源消耗增加，并且存在其他围手术期并发症。然而，在美国 2003 年至 2014 年期间，PHS 与 TJA 患者发生 PE 的风险增加无关。尽管已经认识到 PHS 的潜在危害，但本研究揭示了其他问题，并表明需要进一步改善遗传性高凝障碍患者的围手术期管理。
