Salomon Brett, Krause Peter C, Dasa Vinod, Shi Lizheng, Jones Deryk, Chapple Andrew G
School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Arthroplast Today. 2021 Feb 2;7:200-207. doi: 10.1016/j.artd.2020.12.016. eCollection 2021 Feb.
Millions of Americans have hepatitis C and other liver diseases, many of whom have end-stage osteoarthritis requiring total joint arthroplasty (TJA). This study aimed to determine the extent to which hepatitis C and other liver diseases are independent risk factors for complications, including readmission and reoperation, in patients undergoing TJA.
Retrospective study of a REACHnet data set containing demographics, International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes, and clinical and laboratory data for patients who underwent primary total knee or hip replacement from 2013 to 2017 at 3 hospital systems in Louisiana and Texas. Multivariable logistic regression analyses examined predictors of complications. Any complication was defined as a 90-day medical complication or readmission or reoperation within 1 year.
Among 13,673 patients who met inclusion criteria, 14.9% (2044/13,673) had any complication, 11.7% (1600/13,673) were readmitted within 90 days, and 3.6% (497/13,673) had a reoperation within 1 year. Liver disease increased the odds for any complication (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.18), 90-day medical complication (OR, 1.13; 95% CI, 1.04-1.22), and 90-day readmission (OR, 1.11; 95% CI, 1.06-1.17). Hepatitis C was not, by itself, associated with an increase in any type of complication but was usually associated with liver disease. Comorbidity severity was the strongest predictor of all types of complications after TJA.
Patients in Louisiana and Texas with liver disease were at increased risk for complications after TJA, corroborating findings of previous studies. Hepatitis C was not an independent predictor of complications because of its high association with liver disease.
数以百万计的美国人患有丙型肝炎和其他肝脏疾病，其中许多人患有终末期骨关节炎，需要进行全关节置换术（TJA）。本研究旨在确定丙型肝炎和其他肝脏疾病在接受TJA的患者中成为包括再次入院和再次手术在内的并发症独立危险因素的程度。
对一个REACHnet数据集进行回顾性研究，该数据集包含人口统计学信息、国际疾病分类（ICD）和当前手术操作术语（CPT）编码，以及2013年至2017年在路易斯安那州和得克萨斯州的3个医院系统接受初次全膝关节或髋关节置换术患者的临床和实验室数据。多变量逻辑回归分析检查并发症的预测因素。任何并发症定义为90天内的医疗并发症或1年内的再次入院或再次手术。
在13673例符合纳入标准的患者中，14.9%（2044/13673）发生任何并发症，11.7%（1600/13673）在90天内再次入院，3.6%（497/13673）在1年内进行了再次手术。肝脏疾病增加了发生任何并发症的几率（优势比[OR]，1.12；95%置信区间[CI]，1.08 - 1.18）、90天内医疗并发症的几率（OR，1.13；95%CI，1.04 - 1.22）以及90天内再次入院的几率（OR，1.11；95%CI，1.06 - 1.17）。丙型肝炎本身与任何类型并发症的增加无关，但通常与肝脏疾病相关。合并症严重程度是TJA后所有类型并发症的最强预测因素。
路易斯安那州和得克萨斯州患有肝脏疾病的患者在TJA后发生并发症的风险增加，这证实了先前研究的结果。由于丙型肝炎与肝脏疾病高度相关，它不是并发症的独立预测因素。
