Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
First Affiliation Hospital of Nanchang University, Nanchang City, Jiangxi Province, China.
BMC Musculoskelet Disord. 2021 Oct 9;22(1):860. doi: 10.1186/s12891-021-04738-z.
To study the impact of valvular heart disease (VHD) on hip replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty.
This was a retrospective cohort study. Data on patients who had undergone hip replacement from 2005 to 2014 were extracted from the NIS database. Independent t test and chi-square test were used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time.
VHD accounted for 5.56% and AS accounted for 0.03% of the patients before hip replacement surgeries. Patients with VHD before hip replacement are related to the following characteristics: female patients (odds ratio [OR] = 1.15 [1.12-1.18]), elective admission (OR = 0.78 [0.76-0.80]), Charlson Comorbidity Index ≥3 (OR = 1.06 [1.03-1.08]), large-volume hospitals (OR = 1.13 [1.1-1.2]), teaching hospitals (OR = 5 4.4 [2.9-6.7]), and hospital location in urban areas (OR = 1.22 [1.2-1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR = 2.96 [2.87-3.04]), acute pulmonary edema (OR = 1.13 [1.06-1.21]), acute cerebrovascular event (OR = 1.22 [1.16-1.74]), and acute renal failure (OR = 1.22 [1.17-1.27]). It also has an impact on DVT/PE (OR = 0.89 [0.8-0.99]). Patients with AS before hip replacement have basic demographic characteristics like those of hip replacement patients with valvular disease. Patients with AS are older than those without AS before surgery (OR = 3.28 [2.27-4.75) and are related to the following characteristics: female patients (OR = 1.92 [1.32-2.8]) and elective admission (OR = 0.51 [0.36-0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR = 2.50 [1.76-3.53]) and acute hepatic failure (OR = 7.69 [1.8-32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost.
VHD independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.
研究瓣膜性心脏病（VHD）对髋关节置换的影响，特别是主动脉瓣狭窄（AS）对全髋/半髋关节置换术的临床影响。
这是一项回顾性队列研究。从 NIS 数据库中提取了 2005 年至 2014 年接受髋关节置换术的患者数据。使用独立 t 检验和卡方检验分析患者的基本特征。使用多变量回归估计人口统计学、合并症、并发症、住院费用和时间之间的相关性。
VHD 占髋关节置换术前患者的 5.56%，AS 占 0.03%。髋关节置换术前有 VHD 的患者与以下特征相关：女性患者（比值比[OR] = 1.15 [1.12-1.18]）、择期入院（OR = 0.78 [0.76-0.80]）、Charlson 合并症指数≥3（OR = 1.06 [1.03-1.08]）、大医院（OR = 1.13 [1.1-1.2]）、教学医院（OR = 54.4 [2.9-6.7]）和城市地区的医院位置（OR = 1.22 [1.2-1.3]）。此外，VHD 是死亡率和一些急性术后医疗并发症的危险因素，如急性心脏事件（OR = 2.96 [2.87-3.04]）、急性肺水肿（OR = 1.13 [1.06-1.21]）、急性脑血管事件（OR = 1.22 [1.16-1.74]）和急性肾衰竭（OR = 1.22 [1.17-1.27]）。它还对 DVT/PE（OR = 0.89 [0.8-0.99]）有影响。髋关节置换术前有 AS 的患者具有与瓣膜性疾病髋关节置换患者基本相同的人口统计学特征。术前有 AS 的患者比没有 AS 的患者年龄更大（OR = 3.28 [2.27-4.75]），并与以下特征相关：女性患者（OR = 1.92 [1.32-2.8]）和择期入院（OR = 0.51 [0.36-0.75]）。围手术期仅限于急性术后并发症，如急性心脏事件（OR = 2.50 [1.76-3.53]）和急性肝衰竭（OR = 7.69 [1.8-32.89]）。瓣膜病和 AS 均与更高的死亡率和住院费用相关。
VHD 独立预测了全髋/半髋关节置换术后的死亡率和手术及医疗并发症。
