Gerner Philipp, Memtsoudis Stavros G, Cozowicz Crispiana, Stundner Ottokar, Figgie Mark, Sculco Thomas P, Poultsides Lazaros
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
HSS J. 2022 May;18(2):248-255. doi: 10.1177/15563316211014891. Epub 2021 May 21.
: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. : We sought to investigate the effect of these selection criteria on perioperative outcomes. : In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998-2006) and those who underwent surgery after (2007-2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. : Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. : After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.
与单侧手术相比，双侧全膝关节置换术（BTKA）的并发症风险更高。2006年，为降低这种风险，我们机构实施了选择标准，指定年龄较轻、健康状况较好的患者作为BTKA的候选者。我们试图研究这些选择标准对围手术期结果的影响。在一项回顾性队列研究中，我们使用机构数据识别1998年至2014年间接受BTKA的患者。患者分为两组：在2006年我们的选择标准出台之前接受手术的患者（1998 - 2006年）和之后接受手术的患者（2007 - 2014年）。对两组患者的人口统计学、合并症负担和围手术期并发症发生率进行比较。进行回归分析，计算发病率比以评估并发症发生率的变化。2006年实施选择标准之前，接受BTKA的患者年龄较大，合并症负担较高。每1000个住院日的主要并发症发生率从1998年的31.5降至2014年的7.9。心脏并发症的减少是主要并发症减少的最显著因素。在我们机构实施严格的BTKA候选者标准后，选择年龄较轻、合并症负担较低的患者伴随着手术并发症发生率的降低。这表明引入此类标准可能与围手术期不良结果的减少相关。
