Rosas Samuel, Schallmo Michael, Gowd Anirudh Krishna, Akelman Matthew Reynolds, Luo T David, Emory Cynthia Lynn, Plate Johannes Frank
Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston Salem, NC 27101, United States.
Department of Orthopedic Surgery, Atrium Healthcare, Charlotte, NC 28203, United States.
World J Orthop. 2021 Jun 18;12(6):395-402. doi: 10.5312/wjo.v12.i6.395.
Idiopathic inflammatory myopathies (IIM) are systemic autoimmune disorders such as dermatomyositis (DM), polymyositis (PM), inclusion body myopathy, and autoimmune necrotizing myopathy that, similar to osteoarthritis, affect quality of life and activities of daily living. Moreover, these patients are often burdened with chronic pain and disability; however, the outcomes and risk of total hip arthroplasty (THA) in this patient population remain unclear.
To evaluate 90-d complications and costs in patients with these conditions.
A retrospective case control study was designed by accessing data from the Medicare dataset available on the PearlDiver server. Patients with IIM, here, those with DM and PM were matched based on possible confounding variables to a cohort without these diseases and with the same 10-year risk of mortality as defined by the Charlson Comorbidity Index Score (CCI). Univariate and multivariate analysis were performed to evaluate complications and t-tests to evaluate 90-d Medicare reimbursements as markers of costs after THA.
The total sample was 1090 patients with each cohort comprised of 545. Females were 74.9% of the population. The mean CCI was 5.89 (SD 2.11). Those with IIM had increased rates of pneumonia [odds ratio (OR) 1.45, < 0.001] and pulmonary embolism (OR 1.46, = 0.035) and decreased hematoma risks (OR 0.58, = 0.00). 90-d costs were on average $1411 greater for those with IIM yet not significantly different ( = 0.034).
Patients with IIM have an increased 90-d rate of pneumonia and pulmonary embolism concomitant with a decreased hematoma rate consistent with their pro-coagulatory state. Further attention to increased resource utilization in these patients is also warranted.
特发性炎性肌病（IIM）是系统性自身免疫性疾病，如皮肌炎（DM）、多发性肌炎（PM）、包涵体肌病和自身免疫性坏死性肌病，与骨关节炎类似，会影响生活质量和日常生活活动。此外，这些患者常伴有慢性疼痛和残疾；然而，该患者群体中全髋关节置换术（THA）的结局和风险仍不明确。
评估患有这些疾病的患者90天并发症及费用。
通过访问PearlDiver服务器上的医疗保险数据集设计了一项回顾性病例对照研究。IIM患者，此处指DM和PM患者，根据可能的混杂变量与无这些疾病且具有与Charlson合并症指数评分（CCI）定义的相同10年死亡风险的队列进行匹配。进行单因素和多因素分析以评估并发症，并进行t检验以评估90天医疗保险报销情况，作为THA后费用的指标。
总样本为1090名患者，每个队列由545名组成。女性占人群的74.9%。平均CCI为5.89（标准差2.11）。IIM患者肺炎发生率增加[比值比（OR）1.45，P<0.001]和肺栓塞发生率增加（OR 1.46，P = 0.035），血肿风险降低（OR 0.58，P = <0.001）。IIM患者的90天费用平均高出1411美元，但差异无统计学意义（P = 0.034）。
IIM患者90天肺炎和肺栓塞发生率增加，同时血肿发生率降低，与其促凝状态一致。还需要进一步关注这些患者资源利用增加的问题。
