Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.
Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Sci Rep. 2022 Jun 22;12(1):10579. doi: 10.1038/s41598-022-14749-y.
Venous thromboembolism (VTE) prophylaxis has been suggested for patients who underwent total join arthroplasty (TJA). However, the morbidity of surgical site complications (SSC) and periprosthetic joint infection (PJI) has not been well evaluated. We aimed to evaluate the impact of VTE prophylaxis on the risk of early postoperative SSC and PJI in a Taiwanese population. We retrospectively reviewed 7511 patients who underwent primary TJA performed by a single surgeon from 2010 through 2019. We evaluated the rates of SSC and PJI in the early postoperative period (30-day, 90-day) as well as 1-year reoperations. Multivariate regression analysis was used to identify possible risk factors associated with SSC and PJI, including age, sex, WHO classification of weight status, smoking, diabetes mellitus (DM), rheumatoid arthritis(RA), Charlson comorbidity index (CCI), history of VTE, presence of varicose veins, total knee or hip arthroplasty procedure, unilateral or bilateral procedure, or receiving VTE prophylaxis or blood transfusion. The overall 90-day rates of SSC and PJI were 1.1% (N = 80) and 0.2% (N = 16). VTE prophylaxis was a risk factor for 90-day readmission for SSC (aOR: 1.753, 95% CI 1.081-2.842), 90-day readmission for PJI (aOR: 3.267, 95% CI 1.026-10.402) and all 90-day PJI events (aOR: 3.222, 95% CI 1.200-8.656). Other risk factors included DM, underweight, obesity, bilateral TJA procedure, younger age, male sex and RA. Pharmacological thromboprophylaxis appears to be a modifiable risk factor for SSC and PJI in the early postoperative period. The increased infection risk should be carefully weighed in patients who received pharmacological VTE prophylaxis.
静脉血栓栓塞症（VTE）预防措施已被建议用于接受全膝关节置换术（TJA）的患者。然而，手术部位并发症（SSC）和假体周围关节感染（PJI）的发病率尚未得到很好的评估。我们旨在评估在台湾人群中，VTE 预防措施对早期术后 SSC 和 PJI 风险的影响。我们回顾性分析了 2010 年至 2019 年间由一位外科医生进行的 7511 例初次 TJA 患者。我们评估了术后早期（30 天、90 天）以及 1 年再次手术的 SSC 和 PJI 发生率。多变量回归分析用于确定与 SSC 和 PJI 相关的可能危险因素，包括年龄、性别、世界卫生组织体重状况分类、吸烟、糖尿病（DM）、类风湿关节炎（RA）、Charlson 合并症指数（CCI）、VTE 病史、静脉曲张、全膝关节或髋关节置换术、单侧或双侧手术，或接受 VTE 预防或输血。总的 90 天 SSC 和 PJI 发生率分别为 1.1%（N=80）和 0.2%（N=16）。VTE 预防措施是 90 天 SSC 再入院的危险因素（aOR：1.753，95%CI 1.081-2.842）、90 天 PJI 再入院的危险因素（aOR：3.267，95%CI 1.026-10.402）和所有 90 天 PJI 事件的危险因素（aOR：3.222，95%CI 1.200-8.656）。其他危险因素包括 DM、体重不足、肥胖、双侧 TJA 手术、年龄较小、男性和 RA。药物性血栓预防似乎是术后早期 SSC 和 PJI 的一个可改变的危险因素。在接受药物性 VTE 预防的患者中，应谨慎权衡感染风险增加的问题。
