Halawi Mohamad J, Gronbeck Christian, Metersky Mark L, Wang Yun, Eckenrode Sheila, Mathew Jasie, Suter Lisa G, Eldridge Noel
Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT, USA.
Arthroplast Today. 2021 Sep 22;11:157-162. doi: 10.1016/j.artd.2021.08.010. eCollection 2021 Oct.
Perioperative care for total knee arthroplasty (TKA) has improved over time. We present an analysis of inpatient safety after TKA.
14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System between 2010 and 2017 were retrospectively reviewed. We calculated changes in demographics, comorbidities, and adverse events (AEs) over time. Risk factors for AEs were also assessed.
Between 2010 and 2017, there was an increased prevalence of obesity (35.1% to 57.6%), tobacco smoking (12.5% to 17.8%), and renal disease (5.2% to 8.9%). There were reductions in coronary artery disease (17.3% to 13.4%) and chronic warfarin use (6.7% to 3.1%). Inpatient AEs decreased from 4.9% to 2.5%, ( < .01), primarily driven by reductions in anticoagulant-associated AEs, including major bleeding and hematomas (from 2.8% to 1.0%, < .001), catheter-associated urinary tract infections (1.1% to 0.2%, < .001), pressure ulcers (0.8% to 0.2%, < .001), and venous thromboembolism (0.3% to 0.1%, = .04). The adjusted annual decline in the risk of developing any in-hospital AE was 14% (95% confidence interval [CI] 10%-17%). Factors associated with developing an AE were advanced age (odds ratio [OR] = 1.01, 95% CI 1.00-1.01), male sex (OR = 1.21, 95% CI 1.02-1.44), coronary artery disease (OR = 1.35, 95% CI 1.07-1.70), heart failure (OR = 1.70, 95% CI 1.20-2.41), and renal disease (OR = 1.71, 95% CI 1.23-2.37).
Despite increasing prevalence of obesity, tobacco smoking, and renal disease, inpatient AEs after primary TKA have decreased over the past several years. This improvement is despite the increasing complexity of the inpatient TKA population over time.
随着时间的推移，全膝关节置换术（TKA）的围手术期护理有所改善。我们对TKA术后的住院安全性进行了分析。
回顾性分析了2010年至2017年间医疗保险患者安全监测系统记录的14057例初次TKA病例。我们计算了不同时间点的人口统计学、合并症和不良事件（AE）的变化情况。还评估了AE的危险因素。
2010年至2017年间，肥胖（从35.1%增至57.6%）、吸烟（从12.5%增至17.8%）和肾病（从5.2%增至8.9%）的患病率有所上升。冠状动脉疾病（从17.3%降至13.4%）和长期使用华法林（从6.7%降至3.1%）的情况有所减少。住院AE从4.9%降至2.5%（P<0.01），主要原因是抗凝相关AE减少，包括大出血和血肿（从2.8%降至1.0%，P<0.001）、导管相关尿路感染（从1.1%降至0.2%，P<0.001）、压疮（从0.8%降至0.2%，P<0.001）和静脉血栓栓塞（从0.3%降至0.1%，P=0.04）。发生任何院内AE风险的校正年度下降率为14%（95%置信区间[CI]10%-17%）。与发生AE相关的因素包括高龄（优势比[OR]=1.01，95%CI 1.00-1.01）、男性（OR=1.21，95%CI 1.02-1.44）、冠状动脉疾病（OR=1.35，95%CI 1.07-1.70）、心力衰竭（OR=1.70，95%CI 1.20-2.41）和肾病（OR=1.71，95%CI 1.23-2.37）。
尽管肥胖、吸烟和肾病的患病率有所上升，但在过去几年中，初次TKA术后的住院AE有所减少。尽管随着时间的推移，住院TKA患者群体的复杂性增加，但仍实现了这一改善。
