Lan Pingwen, Chen Xi, Fang Zhi, Zhang Jianjun, Liu Shuping, Liu Yuehong
Department of Orthopedics, People's Hospital of Deyang City, Deyang, China.
Front Surg. 2022 May 11;9:829303. doi: 10.3389/fsurg.2022.829303. eCollection 2022.
The growing number of patients undergoing total hip arthroplasty (THA) and postoperative outcomes receive increasing attention from doctors and patients. This study aimed to elucidate the effects of comorbidities on postoperative function, pain, complications, readmission rate, and mortality.
We included consecutive patients who underwent primary unilateral THA between 2017 and 2019. The Charlson comorbidity index (CCI) and the WOMAC and SF-36 (physical function, body pain) scales were assessed preoperatively and at 3, 6, 12, and 24 months postoperatively. The complications, 30-day readmission, and mortality rates assessed the impact of comorbidities and their changes over time on the WOMAC and SF-36 scores during follow-up. We used mixed model linear regression to examine the association of worsening comorbidity post-THA with change in WOMAC and SF-36 scores in the subsequent follow-up periods, controlling for age, length of follow-up, and repeated observations.
This study included 468 patients, divided into four groups based on comorbidity burden (CCI-0, 1, 2, and ≥3). The physiological function recovery and pain scores in the CCI ≥ 3 group were inferior to the other groups and took longer than the other groups (6 vs. 3 months) to reach their best level. The four groups preoperative waiting times were 2.41 ± 0.74, 2.97 ± 0.65, 3.80 ± 0.53, and 5.01 ± 0.71 days, respectively. The complications, 30-day readmission, and 1-year mortality rates for the overall and the CCI ≥ 3 group were 1.92% and 4.69%, 0.85% and 2.01%, and 0.43% and 1.34%, respectively, with no mortality in the other groups.
Patients with higher CCI were more susceptible to physical function and pain outcome deterioration, experienced longer waiting time before surgery, took longer to recover, and had higher rates of complications, 30-day readmission, and mortality after THA. Older age in the group led to a greater impact.
接受全髋关节置换术（THA）的患者数量不断增加，其术后结果受到医生和患者越来越多的关注。本研究旨在阐明合并症对术后功能、疼痛、并发症、再入院率和死亡率的影响。
我们纳入了2017年至2019年间接受初次单侧THA的连续患者。术前以及术后3、6、12和24个月评估Charlson合并症指数（CCI）以及WOMAC和SF-36（身体功能、身体疼痛）量表。并发症、30天再入院率和死亡率评估了合并症及其随时间的变化对随访期间WOMAC和SF-36评分的影响。我们使用混合模型线性回归来检验THA后合并症恶化与后续随访期WOMAC和SF-36评分变化之间的关联，同时控制年龄、随访时间和重复观察。
本研究纳入了468例患者，根据合并症负担分为四组（CCI-0、1、2和≥3）。CCI≥3组的生理功能恢复和疼痛评分低于其他组，达到最佳水平的时间比其他组长（6个月对3个月）。四组术前等待时间分别为2.41±0.74、2.97±0.65、3.80±0.53和5.01±0.71天。总体组和CCI≥3组的并发症、30天再入院率和1年死亡率分别为1.92%和4.69%、0.85%和2.01%、0.43%和1.34%，其他组无死亡病例。
CCI较高的患者更容易出现身体功能和疼痛结果恶化，术前等待时间更长，恢复时间更长，THA后并发症、30天再入院率和死亡率更高。该组中年龄较大导致的影响更大。
