人工关节周围感染中“老年骨科感染”术语的定义。
The Definition of the Term "Orthogeriatric Infection" for Periprosthetic Joint Infections.
作者信息
Walter Nike, Rupp Markus, Bärtl Susanne, Uecker Claus, Alt Volker
机构信息
Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.
出版信息
Geriatr Orthop Surg Rehabil. 2022 Jun 30;13:21514593221111649. doi: 10.1177/21514593221111649. eCollection 2022.
INTRODUCTION
In the background of the aging population, an increase of geriatric patients with specific age-related co-morbidities has already been seen over the years for proximal femur fractures in orthopaedic surgery as well as other medical disciplines. However, the geriatric aspect has not been well recognized in periprosthetic joint infection (PJI) patients so far. Therefore, this paper seeks to provide an overview on the co-morbidities of PJI patients with respect to the definition of geriatric patients.
MATERIAL AND METHODS
In this single-center retrospective study, patients treated between 2007 and 2020 for PJI were included (n = 255). Patients were defined as geriatric according to the consensus definition criteria of the Federal Working Group of Clinical Geriatric Facilities e.V., the German Society for Geriatrics e.V. and the German Society for Gerontology and Geriatrics e.V. based on age (≤70 years), geriatric multimorbidity and the Barthel index (≤30).
RESULTS
Applying the criteria defined 184 of the 255 (72.2%) PJI patients as geriatric infection patients. Regarding geriatric comorbidity, incontinence was most prevalent (38.1%), followed by immobility (25.6%). Comparing the geriatric infection patients with those classified as non-geriatric (n = 71 revealed that geriatric patients had a longer hospital stay and spent more days in the intensive care unit (ICU). Also, the amputation rate and the 5-year mortality rate was significantly increased (n = 15, 8.2% vs n = 1, 1.4%, = .007 and n = 24, 13.0% vs n = 5, 7.0%, = .005). The Barthel index showed a significant correlation with mortality ( = -.22, = .011).
DISCUSSION
We propose to use the term orthogeriatric infection patients in those cases in order to focus treatment not only on the orthopaedic infections but also on the important geriatric aspects.
CONCLUSION
The inclusion of geriatric physicians into the multidisciplinary team approach for PJI patients might be beneficial.
引言
在人口老龄化的背景下，多年来，在骨科手术以及其他医学学科中，因股骨近端骨折而出现的特定年龄相关合并症的老年患者数量有所增加。然而，迄今为止，老年因素在假体周围关节感染（PJI）患者中尚未得到充分认识。因此，本文旨在就老年患者的定义，对PJI患者的合并症进行概述。
材料与方法
在这项单中心回顾性研究中，纳入了2007年至2020年期间接受PJI治疗的患者（n = 255）。根据联邦临床老年医学设施工作组、德国老年医学协会和德国老年学与老年医学协会的共识定义标准，基于年龄（≤70岁）、老年多重疾病和巴氏指数（≤30）将患者定义为老年患者。
结果
应用所定义的标准，255例PJI患者中有184例（72.2%）被判定为老年感染患者。关于老年合并症，失禁最为常见（38.1%），其次是活动不便（25.6%）。将老年感染患者与非老年患者（n = 71）进行比较发现，老年患者住院时间更长，在重症监护病房（ICU）的天数更多。此外，截肢率和5年死亡率显著增加（n = 15，8.2% 对 n = 1，1.4%，P = .007；n = 24，13.0% 对 n = 5，7.0%，P = .005）。巴氏指数与死亡率呈显著相关性（P = -.22，P = .011）。
讨论
我们建议在这些病例中使用“老年骨科感染患者”这一术语，以便治疗不仅关注骨科感染，还关注重要的老年因素。
结论
将老年医学医生纳入PJI患者的多学科团队治疗方法可能有益。
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