Shah Vikram Indrajit, Pachore Javahir A, Upadhyay Sachin, Shah Kalpesh, Seth Ashish, Kshatriya Amish, Patil Jayesh, Gujjar Pranay, Kantesariya Milan
Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat India.
Department of Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat India.
Indian J Orthop. 2021 Nov 11;56(4):646-654. doi: 10.1007/s43465-021-00559-3. eCollection 2022 Apr.
The primary objective was to ascertain the predictors of 90-day all-cause morbidity, mortality and poor functional outcome scores following primary total knee arthroplasty (TKA).
The study population comprised 3645 patients who underwent elective primary unilateral TKA at our institution. Demographic variables, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) grade and the Deyo-Charlson comorbidity scores were ascertained. The Functional outcomes, perioperative complications, mortality and readmission rates were monitored prospectively for 90 days and analysed. Patients were assessed twice: at baseline and at 90 days postoperatively. Odds ratio and the corresponding 95% confidence intervals were calculated to quantify the risk. A < 0.05 for two-tailed tests were considered significant.
The 90-day mortality rate was 0.08% (all males) and 3.95% of the patients experienced one or the other complications. The majority of patients reported excellent-to-poor scores at 90-day follow-up VAS (8.85 ± 1.02 vs. 2.65 ± 1.15; < 0.0001) and KSS scores (42.96 ± 5.90 vs. 80.52 ± 4.15; < 0.0001). The early readmission rate was 0.96%. Infection was being the primary reason. Age > 70 years; Deyo-Charlson co-morbidity score ≥ 4, ASA grade-III, Diabetes Mellitus, BMI > 35, Cardiac Issues and Male gender were significant predictors of early morbidity and mortality. Female, Deyo-Charlson comorbidity score ≥ 4, ASA grade-III, BMI > 35, Age > 75 years and poor preoperative scores were significantly associated with poor functional outcome.
The present study explicates the relative importance of predictors on morbidity, mortality and functional outcome. Efforts to minimize morbidity and mortality should concentrate more on elderly male patients, and those with high Deyo-Charlson comorbidity score, BMI and ASA grade.
主要目的是确定初次全膝关节置换术（TKA）后90天全因发病率、死亡率及功能预后不良评分的预测因素。
研究人群包括在我院接受择期初次单侧TKA的3645例患者。确定人口统计学变量、体重指数（BMI）、美国麻醉医师协会（ASA）分级及Deyo-Charlson合并症评分。前瞻性监测90天的功能预后、围手术期并发症、死亡率及再入院率并进行分析。患者在基线和术后90天接受两次评估。计算比值比及相应的95%置信区间以量化风险。双侧检验P < 0.05被认为具有显著性。
90天死亡率为0.08%（均为男性），3.95%的患者出现一种或多种并发症。大多数患者在90天随访时VAS评分（8.85±1.02对2.65±1.15；P < 0.0001）和KSS评分（42.96±5.90对80.52±4.15；P < 0.0001）显示从差到优。早期再入院率为0.96%。感染是主要原因。年龄>70岁；Deyo-Charlson合并症评分≥4、ASAⅢ级、糖尿病、BMI>35、心脏问题及男性是早期发病和死亡的显著预测因素。女性、Deyo-Charlson合并症评分≥4、ASAⅢ级、BMI>35、年龄>75岁及术前评分差与功能预后不良显著相关。
本研究阐明了预测因素对发病率、死亡率及功能预后的相对重要性。降低发病率和死亡率的努力应更多地集中在老年男性患者以及Deyo-Charlson合并症评分高、BMI高和ASA分级高的患者身上。
