肌肉量低是全膝关节置换术后输血的独立危险因素：一项回顾性、倾向评分匹配队列研究。
Low muscle mass is an independent risk factor for postoperative blood transfusion in total knee arthroplasty: a retrospective, propensity score-matched cohort study.
机构信息
Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
出版信息
BMC Geriatr. 2022 Mar 17;22(1):218. doi: 10.1186/s12877-022-02903-0.
BACKGROUND
Sarcopenia, an age-related loss of skeletal muscle mass and function, is correlated with adverse outcomes after some surgeries. This study examined the characteristics of sarcopenic patients undergoing primary total knee arthroplasty (TKA), and identified low muscle mass as an independent risk factor for postoperative TKA complications.
METHODS
A retrospective cohort study examined 452 patients who underwent TKA. The skeletal muscle index (SMI) was obtained via bioelectrical impedance analysis (BIA), along with demographics, the Charlson Comorbidity Index, and medication, laboratory and operative data for 2018-2021. Patients were categorized into normal (n = 417) and sarcopenic (n = 35) groups using the SMI cut-off suggested by the Asian Working Group for Sarcopenia 2019 (males, < 7.0 kg/m; females, < 5.7 kg/m). Three postoperative complications were analysed: blood transfusion, delirium, and acute kidney injury (AKI). Baseline characteristics were propensity score-matched to address potential bias and confounding factors.
RESULTS
The proportion of sarcopenic patients in primary TKA was 7.7% (35/452). The sarcopenic group had a lower preoperative haemoglobin (12.18 ± 1.20 vs. 13.04 ± 1.73 g/dL, p = 0.004) and total protein (6.73 ± 0.42 vs. 7.06 ± 0.44 mg/dL, p = 0.001). Propensity scoring matching and logistic regression showed that more patients in the sarcopenic group received postoperative blood transfusions (OR = 6.60, 95% CI: 1.57-45.5, p = 0.021); there was no significant difference in AKI or delirium. Univariate receiver operating characteristic curve analysis of the propensity-matched group, to determine the predictive value of SMI for postoperative transfusion, gave an AUC of 0.797 (0.633-0.96) and SMI cut-off of 5.6 kg/m.
CONCLUSIONS
Low muscle mass determined by BIA was an independent risk factor for postoperative transfusion in TKA. Multifrequency BIA can serve as a screening tool for sarcopenia that may influence the orthopaedic decision-making process or treatment planning in patients with sarcopenia undergoing primary TKA.
LEVEL OF EVIDENCE
III, retrospective cohort study.
背景
肌肉减少症是一种与某些手术后不良结局相关的与年龄相关的骨骼肌质量和功能丧失。本研究检查了接受初次全膝关节置换术（TKA）的肌肉减少症患者的特征，并确定低肌肉质量是术后 TKA 并发症的独立危险因素。
方法
回顾性队列研究纳入了 2018 年至 2021 年间接受 TKA 的 452 名患者。通过生物电阻抗分析（BIA）获得骨骼肌指数（SMI），并记录患者的人口统计学、Charlson 合并症指数以及药物、实验室和手术数据。使用 2019 年亚洲肌肉减少症工作组建议的 SMI 截断值（男性，<7.0kg/m；女性，<5.7kg/m）将患者分为正常（n=417）和肌肉减少症（n=35）组。分析了三种术后并发症：输血、谵妄和急性肾损伤（AKI）。采用倾向评分匹配来解决潜在的偏倚和混杂因素。
结果
初次 TKA 中肌肉减少症患者的比例为 7.7%（35/452）。肌肉减少症组术前血红蛋白（12.18±1.20 vs. 13.04±1.73g/dL，p=0.004）和总蛋白（6.73±0.42 vs. 7.06±0.44mg/dL，p=0.001）水平较低。倾向评分匹配和逻辑回归显示，肌肉减少症组更多患者接受术后输血（OR=6.60，95%CI：1.57-45.5，p=0.021）；AKI 或谵妄无显著差异。对倾向评分匹配组进行单变量受试者工作特征曲线分析，以确定 SMI 对术后输血的预测价值，得出 AUC 为 0.797（0.633-0.96），SMI 截断值为 5.6kg/m。
结论
BIA 确定的低肌肉质量是 TKA 术后输血的独立危险因素。多频 BIA 可作为肌肉减少症的筛查工具，可能影响肌肉减少症患者初次 TKA 的骨科决策过程或治疗计划。
证据等级
III，回顾性队列研究。
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