College of Medicine, University of Arizona, 475 N 5th street, Phoenix, AZ, 85031, USA.
Department of Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus.
Clin Rheumatol. 2022 Jun;41(6):1817-1824. doi: 10.1007/s10067-022-06101-6. Epub 2022 Feb 17.
This cross-sectional study aims to evaluate the predictors, outcomes, and resource utilization of total knee arthroplasty (TKA) in calcium pyrophosphate deposition disease (CPPD) patients. We used the US National Inpatient Sample database to identify CPPD and non-CPPD who underwent TKA from 2006 to 2014. Data collection included patient demographics and comorbidities. Outcomes following TKA included in-hospital mortality, complications, length of hospitalization, hospital charges, and disposition. Among the 5,564,005 patients who have undergone TKA, 11,529 (0.20%) had CPPD, with a median age of 72 years, and 53.7% were females. Compared with non-CPPD, patients with CPPD were more likely to be older (mean 72 vs 66 years; p < 0.001), male, white, and have Medicare insurance. CPPD patients were more likely to have ≥ 2 comorbidities calculated by the Charlson Comorbidity Index and discharge to an inpatient/rehabilitation facility. Regarding inpatient complications, myocardial infarction and knee reoperation were significantly more common in CPPD patients. TKA in CPPD patients was associated with significantly higher odds of increased length of stay (> 3 days) than those without CPPD (OR 1.43, 95% CI 1.37-1.49). There was no significant difference in the in-hospital mortality even after adjusting for possible confounders. CPPD patients who underwent TKA were more likely to have a longer hospital stay and discharge to a non-home setting than non-CPPD. Also, CPPD patients had a higher comorbidity burden and risk for myocardial infarction and reoperation.Key Points• This is the largest study to analyze data of CPPD patients who underwent TKA and compare them with non-CPPD patients, using a large nationwide database.• Compared to non-CPPD patients, TKA in CPPD patients is associated with a greater length of stay and disposition to a nursing/rehabilitation facility.• In-hospital complications such as myocardial infarction and reoperation were more frequently observed in CPPD patients than non-CPPD.• The results of this study should alert healthcare providers to develop strategies in order to improve outcomes of CPPD patients undergoing TKA.
这项横断面研究旨在评估焦磷酸钙沉积病（CPPD）患者行全膝关节置换术（TKA）的预测因素、结局和资源利用情况。我们使用美国国家住院患者样本数据库，从 2006 年至 2014 年确定接受 TKA 的 CPPD 和非 CPPD 患者。数据收集包括患者人口统计学特征和合并症。TKA 后的结局包括院内死亡率、并发症、住院时间、住院费用和出院去向。在接受 TKA 的 5564005 名患者中，11529 名（0.20%）患有 CPPD，中位年龄为 72 岁，53.7%为女性。与非 CPPD 患者相比，CPPD 患者年龄更大（平均 72 岁比 66 岁；p<0.001），男性更多，白人更多，且更多人有医疗保险。CPPD 患者更有可能有Charlson 合并症指数计算的≥2 种合并症，且出院至住院/康复机构。就院内并发症而言，心肌梗死和膝关节翻修在 CPPD 患者中更为常见。与非 CPPD 患者相比，CPPD 患者 TKA 后住院时间延长（>3 天）的可能性显著更高（OR 1.43，95%CI 1.37-1.49）。即使在调整了可能的混杂因素后，院内死亡率也无显著差异。与非 CPPD 患者相比，接受 TKA 的 CPPD 患者更有可能住院时间更长，出院去向非家庭环境。此外，CPPD 患者的合并症负担更重，发生心肌梗死和翻修的风险更高。关键点：• 这是迄今为止分析接受 TKA 的 CPPD 患者数据并与非 CPPD 患者进行比较的最大规模研究，使用了大型全国性数据库。• 与非 CPPD 患者相比，CPPD 患者行 TKA 后住院时间更长，更倾向于出院至护理/康复机构。• CPPD 患者比非 CPPD 患者更常发生院内并发症，如心肌梗死和翻修。• 本研究结果应提醒医疗保健提供者制定策略，以改善接受 TKA 的 CPPD 患者的结局。
