Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland.
Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.
Bone Joint J. 2022 Jun;104-B(6):696-702. doi: 10.1302/0301-620X.104B6.BJJ-2021-1486.R1.
Periprosthetic joint infections (PJIs) and fracture-related infections (FRIs) are associated with a significant risk of adverse events. However, there is a paucity of data on cardiac complications following revision surgery for PJI and FRI and how they impact overall mortality. Therefore, this study aimed to investigate the risk of perioperative myocardial injury (PMI) and mortality in this patient cohort.
We prospectively included consecutive patients at high cardiovascular risk (defined as age ≥ 45 years with pre-existing coronary, peripheral, or cerebrovascular artery disease, or any patient aged ≥ 65 years, plus a postoperative hospital stay of > 24 hours) undergoing septic or aseptic major orthopaedic surgery between July 2014 and October 2016. All patients received a systematic screening to reliably detect PMI, using serial measurements of high-sensitivity cardiac troponin T. All-cause mortality was assessed at one year. Multivariable logistic regression models were applied to compare incidence of PMI and mortality between patients undergoing septic revision surgery for PJI or FRI, and patients receiving aseptic major bone and joint surgery.
In total, 911 consecutive patients were included. The overall perioperative myocardial injury (PMI) rate was 15.4% (n = 140). Septic revision surgery for PJI was associated with a significantly higher PMI rate (43.8% (14/32) vs 14.5% (57/393); p = 0.001) and one-year mortality rate (18.6% (6/32) vs 7.4% (29/393); p = 0.038) compared to aseptic revision or primary arthroplasty. The association with PMI persisted in multivariable analysis with an adjusted odds ratio (aOR) of 4.7 (95% confidence interval (CI) 2.1 to 10.7; p < 0.001), but was not statistically significant for one-year mortality (aOR 1.9 (95% CI 0.7 to 5.4; p = 0.240). PMI rate (15.2% (5/33) vs 14.1% (64/453)) and one-year mortality (15.2% (5/33) vs 9.1% (41/453)) after FRI revision surgery were comparable to aseptic long-bone fracture surgery.
Patients undergoing revision surgery for PJI were at a risk of PMI and death compared to those undergoing aseptic arthroplasty surgery. Screening for PMI and treatment in specialized multidisciplinary units should be considered in major bone and joint infections. Cite this article: 2022;104-B(6):696-702.
假体周围关节感染（PJI）和骨折相关感染（FRI）与不良事件的发生风险显著相关。然而，关于 PJI 和 FRI 翻修手术后的心脏并发症以及它们如何影响总体死亡率的数据却很少。因此，本研究旨在调查此类患者发生围手术期心肌损伤（PMI）和死亡的风险。
我们前瞻性纳入了 2014 年 7 月至 2016 年 10 月间患有 PJI 或 FRI 的高心血管风险（定义为年龄≥45 岁且存在冠状动脉、外周或脑血管疾病，或任何年龄≥65 岁且术后住院时间>24 小时）的连续患者。所有患者均接受了系统的筛查，以使用高敏心肌肌钙蛋白 T 的连续测量可靠地检测 PMI。在 1 年时评估全因死亡率。应用多变量逻辑回归模型比较行 PJI 或 FRI 翻修术的脓毒症患者与行无菌性大骨科手术患者的 PMI 发生率和死亡率。
共纳入了 911 例连续患者。总体围手术期心肌损伤（PMI）发生率为 15.4%（n=140）。与无菌性翻修或初次关节置换术相比，PJI 翻修术后发生的脓毒症与显著更高的 PMI 发生率（43.8%（14/32）与 14.5%（57/393）；p=0.001）和 1 年死亡率（18.6%（6/32）与 7.4%（29/393）；p=0.038）相关。多变量分析中，这种与 PMI 的关联仍然存在，调整后的优势比（aOR）为 4.7（95%置信区间（CI）2.1 至 10.7；p<0.001），但 1 年死亡率无统计学意义（aOR 1.9（95%CI 0.7 至 5.4；p=0.240）。FRI 翻修术后的 PMI 发生率（15.2%（5/33）与 14.1%（64/453））和 1 年死亡率（15.2%（5/33）与 9.1%（41/453））与无菌性长骨骨折手术相当。
与无菌性关节置换术相比，PJI 翻修术患者发生 PMI 和死亡的风险更高。在大型骨科感染中，应考虑进行 PMI 筛查和在多学科专业治疗单位进行治疗。
2022；104-B（6）：696-702.
