Department of MSK Oncology, University of Calgary, Calgary, AB, Canada.
School of Medicine, University of Texas Medical Branch, Texas, USA.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3291-3298. doi: 10.1007/s00402-022-04581-4. Epub 2022 Aug 17.
Consequent to improved life expectancies, there has been a substantial increase in the proportion of patients with systemic lupus erythematosus (SLE) undergoing total knee arthroplasty (TKA) over the past 2 decades. In comparison to the other inflammatory disorders, the complication rates and post-operative outcome in patients with SLE are less clearly understood, owing to the paucity of evidence in the literature.
Patients who underwent TKA between 2016 and 2019 were identified (ICD-10CMP code) using the National Inpatient Sample (NIS) database and then classified into one of the two groups, namely those with SLE (ICD-10-CM; code710.0) and those without SLE (NSLE). Demographic details, co-morbidities, details regarding hospital stay, costs incurred, and complications encountered of this patient cohort were analysed and compared between the two groups.
Overall, among 5,58,361 patients undergoing TKA, 2,094 (0.38%) patients had SLE. The SLE group was significantly younger than NSLE population (62.2 ± 9.9 vs 66.7 ± 9.5 years; p < 0.001). The proportion of female and African-American patients was higher in the SLE group (p < 0.001). SLE patients had a significantly longer hospital stay (p < 0.001) and greater hospital-related expenditure (p < 0.001). Among the peri-operative complications, SLE patients had significantly greater risk of developing post-operative anemia (19.2% in SLE vs 15.3% in NSLE; p < 0.001), requiring blood transfusion (2.8% in SLE vs 1.5% in NSLE; p < 0.001), and acquiring peri-prosthetic joint infections (1.9% in SLE vs 1% in NSLE; p < 0.001).
The presence of SLE significantly lengthens hospital stay, and augments the health-care-related costs in patients undergoing TKA. The rates of peri-prosthetic infections, post-operative anemia, and need for blood transfusions are significantly greater in SLE patients.
随着预期寿命的提高，在过去的 20 年中，接受全膝关节置换术 (TKA) 的系统性红斑狼疮 (SLE) 患者比例大幅增加。与其他炎症性疾病相比，由于文献中证据不足，SLE 患者的并发症发生率和术后结局尚不清楚。
使用国家住院患者样本 (NIS) 数据库，通过国际疾病分类第 10 次修订版临床修正 (ICD-10CMP) 代码识别 2016 年至 2019 年间接受 TKA 的患者，并将其分为两组，即患有 SLE（ICD-10-CM；代码 710.0）和不患有 SLE（NSLE）的患者。分析和比较了这组患者的人口统计学细节、合并症、住院时间、费用和并发症。
总体而言，在接受 TKA 的 558361 名患者中，有 2094 名（0.38%）患有 SLE。SLE 组明显比 NSLE 人群年轻（62.2 ± 9.9 岁 vs 66.7 ± 9.5 岁；p<0.001）。SLE 组中女性和非裔美国人的比例较高（p<0.001）。SLE 患者的住院时间明显更长（p<0.001），医疗相关费用更高（p<0.001）。在围手术期并发症中，SLE 患者术后贫血的风险显著增加（SLE 组为 19.2%，NSLE 组为 15.3%；p<0.001），需要输血（SLE 组为 2.8%，NSLE 组为 1.5%；p<0.001），以及获得假体关节周围感染（SLE 组为 1.9%，NSLE 组为 1%；p<0.001）。
SLE 的存在显著延长了住院时间，并增加了接受 TKA 治疗的患者的医疗保健相关费用。SLE 患者假体周围感染、术后贫血和输血的发生率显著增加。
