MacMahon Aoife, Rao Sandesh S, Chaudhry Yash P, Hasan Syed A, Epstein Jeremy A, Hegde Vishal, Valaik Daniel J, Oni Julius K, Sterling Robert S, Khanuja Harpal S
Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
HSS J. 2022 Aug;18(3):418-427. doi: 10.1177/15563316211030923. Epub 2021 Jul 30.
Total joint arthroplasty (TJA) is one of the most common procedures performed in the United States. Outcomes of this elective procedure may be improved via preoperative optimization of modifiable risk factors. We sought to summarize the literature on the clinical implications of preoperative risk factors in TJA and to develop recommendations regarding preoperative optimization of these risk factors. We searched PubMed in August 2019 with an update in September 2020 for English-language, peer-reviewed publications assessing the influence on outcomes in total hip and knee replacement of 7 preoperative risk factors-obesity, malnutrition, hypoalbuminemia, diabetes, anemia, smoking, and opioid use-and recommendations to mitigate them. Sixty-nine studies were identified, including 3 randomized controlled trials, 8 prospective cohort studies, 42 retrospective studies, 6 systematic reviews, 3 narrative reviews, and 7 consensus guidelines. These studies described worse outcomes associated with these 7 risk factors, including increased rates of in-hospital complications, transfusions, periprosthetic joint infections, revisions, and deaths. Recommendations for strategies to screen and address these risk factors are provided. Risk factors can be optimized, with evidence suggesting the following thresholds prior to surgery: a body mass index <40 kg/m, serum albumin ≥3.5 g/dL, hemoglobin A1C ≤7.5%, hemoglobin >12.0 g/dL in women and >13.0 g/dL in men, and smoking cessation and ≥50% decrease in opioid use by 4 weeks prior to surgery. Surgery should be delayed until these risk factors are adequately optimized.
全关节置换术（TJA）是美国最常见的手术之一。通过术前优化可改变的风险因素，这种择期手术的效果可能会得到改善。我们试图总结关于TJA术前风险因素临床意义的文献，并就这些风险因素的术前优化提出建议。我们于2019年8月检索了PubMed，并在2020年9月进行了更新，以查找英文、经同行评审的出版物，这些出版物评估了7种术前风险因素——肥胖、营养不良、低白蛋白血症、糖尿病、贫血、吸烟和阿片类药物使用——对全髋关节和膝关节置换术结果的影响以及减轻这些风险因素的建议。共识别出69项研究，包括3项随机对照试验、8项前瞻性队列研究、42项回顾性研究、6项系统评价、3项叙述性综述和7项共识指南。这些研究描述了与这7种风险因素相关的较差结果，包括住院并发症、输血、假体周围关节感染、翻修手术和死亡发生率的增加。文中提供了筛查和处理这些风险因素的策略建议。风险因素可以得到优化，有证据表明术前应达到以下阈值：体重指数<40kg/m²，血清白蛋白≥3.5g/dL，糖化血红蛋白≤7.5%，女性血红蛋白>12.0g/dL，男性血红蛋白>13.0g/dL，术前4周戒烟且阿片类药物使用量减少≥50%。手术应推迟到这些风险因素得到充分优化之后。
