Hamaway Stefan, Hadid Bana, Vakharia Rushabh M, Ng Mitchell K, Gordon Adam M, Roche Martin W, Razi Afshin E
Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA.
College of Medicine, State University of New York Downstate, Brooklyn, NY, USA.
Arthroplasty. 2022 Jul 27;4(1):34. doi: 10.1186/s42836-022-00129-4.
Recent studies show an increase in the prevalence of iron deficiency anemia (IDA) worldwide and a concomitant rise in the number of revision total knee arthroplasty (RTKA). The literature evaluating the association between IDA and perioperative outcomes following RTKA are limited. Therefore, the purpose of this study was to determine whether IDA patients undergoing RTKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) complications; and (3) costs.
Using International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT), a retrospective query was performed from January 1, 2005 to March 31, 2014. The inclusion criteria consisted of those patients who have IDA undergoing RTKA. Study group patients were 1:5 ratio matched to a comparison cohort by age, sex, and various comorbidities: coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus, hyperlipidemia, hypertension, obesity, and tobacco use, yielding a total of 106,534 patients within the study (n = 17,784) and control (n = 88,750) cohorts. Outcomes assessed included: in-hospital LOS, costs of care, and medical complications. Multivariate Logistic regression analyses were used to calculate the odds-ratios (OR) and respective 95% confidence intervals (95%CI). Welch's t-tests were used to compare in-hospital LOS and costs of care. Following Bonferroni-correction, a P-value less than 0.001 was considered statistically significant.
IDA patients undergoing RTKA were found to have significantly higher in-hospital LOS (4-days vs. 3-days, P < 0.0001). Additionally, IDA patients were found to have significantly higher odds (OR) of medical complications (OR: 5.29, P < 0.0001) such as: pneumonia (OR: 6.86, P < 0.0001), respiratory failures (OR: 5.95, P < 0.0001), myocardial infarctions (OR: 4.31, P < 0.0001) and other complications. Furthermore, IDA patients incurred significantly higher day of surgery ($16,976.01 vs. $14,515.81, P < 0.0001) and 90-day costs ($22,548.71 vs. $16,819.15, P < 0.0001).
The study demonstrated IDA patients undergoing RTKA have higher rates of in-hospital LOS, costs of care, and medical complications. Orthopedic surgeons and other healthcare professionals can use this information to adequately educate these patients of the potential complications following their procedure.
近期研究表明，全球范围内缺铁性贫血（IDA）的患病率有所上升，同时翻修全膝关节置换术（RTKA）的数量也随之增加。评估IDA与RTKA术后围手术期结局之间关联的文献有限。因此，本研究的目的是确定接受RTKA的IDA患者是否在以下方面具有更高的发生率：（1）住院时间（LOS）；（2）并发症；以及（3）费用。
使用国际疾病分类第九版（ICD - 9）和当前手术操作术语（CPT），对2005年1月1日至2014年3月31日进行了回顾性查询。纳入标准包括那些接受RTKA的IDA患者。研究组患者与对照组按年龄、性别和各种合并症（冠状动脉疾病、慢性阻塞性肺疾病、糖尿病、高脂血症、高血压、肥胖和吸烟）以1:5的比例进行匹配，研究队列（n = 17,784）和对照队列（n = 88,750）共计106,534名患者。评估的结局包括：住院LOS、护理费用和医疗并发症。使用多因素逻辑回归分析来计算比值比（OR）和相应的95%置信区间（95%CI）。采用韦尔奇t检验来比较住院LOS和护理费用。经过邦费罗尼校正后，P值小于0.001被认为具有统计学意义。
发现接受RTKA的IDA患者住院LOS显著更长（4天对3天，P < 0.0001）。此外，发现IDA患者发生医疗并发症的几率（OR）显著更高（OR：5.29，P < 0.0001），例如：肺炎（OR：6.86，P < 0.0001）、呼吸衰竭（OR：5.95，P < 0.0001）、心肌梗死（OR：4.31，P < 0.0001）和其他并发症。此外，IDA患者手术当天的费用（16,976.01美元对14,515.81美元，P <
