初次肩关节置换术后，先前的牙科病史对医疗并发症和假体周围关节感染的影响。
The influence of prior dental pathology on medical complications and peri-prosthetic joint infections following primary shoulder arthroplasty.
机构信息
Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA.
出版信息
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1913-1919. doi: 10.1007/s00590-022-03378-w. Epub 2022 Aug 28.
PURPOSE
Antibiotic prophylaxis before invasive dental procedures is a common practice in the USA. Consensus regarding the influence of prior dental pathology (DP) on postoperative complications is lacking. The objectives are to determine the association of DP prior to shoulder arthroplasty (SA) on: (1) lengths of stay (LOS), (2) medical complications, (3) readmissions, (4) implant-related complications including peri-prosthetic joint infections (PJIs) and (5) healthcare expenditures.
METHODS
The PearlDiver database was queried for primary shoulder arthroplasty from 2010 to 2020. Patients with history of dental caries or dental implant placement before SA represented the study group (n = 1419). Patients without prior DP represented controls (n = 7062). Study group patients were 1:5 ratio matched to controls by age, sex, and comorbidities. Outcomes included LOS, 90-day complications, readmissions, 2-year implant-related complications, and healthcare reimbursements. Logistic regression was used to calculate odds ratios (OR) of complications and readmissions. T tests compared LOS and costs. P values < 0.003 were significant.
RESULTS
LOS (2.17 vs. 2.07 days; p = 0.071) were similar between groups. Patients with DP had higher 90-day medical complications compared to controls (OR: 1.74, p < 0.0001), including myocardial infarctions (2.2% vs. 0.8%; OR: 2.79, p < 0.0001), acute kidney injuries (8.3% vs. 4.6%; OR: 1.92, p < 0.0001), and pneumonias (8.7% vs. 5.3%; OR: 1.72, p < 0.0001). Readmission rates (1.97% vs. 1.54%; p = 0.248) were similar. Two-year implant complications were higher in patients with DP compared to controls (16.1% vs. 11.5%; OR: 1.38, p = 0.0003), including dislocations (6.4% vs. 4.5%; OR: 1.45, p = 0.002) and mechanical loosenings (4.0% vs. 2.4%; OR: 1.67, p = 0.001); however, PJIs were similar (2.2% vs. 1.9%; OR: 1.12, p = 0.583). Healthcare expenditures between groups were similar ($12,611 vs. $12,059; p = 0.075).
CONCLUSION
Patients with prior DP have higher 90-day medical complications and 2-year implant-related complications. Two-year incidence of PJIs were similar between groups. These findings can help shoulder surgeons counsel patients with a pertinent dental history.
LEVEL OF EVIDENCE III
Retrospective comparative study.
目的
在美国，在进行有创性牙科手术前使用抗生素预防是一种常见做法。然而，对于先前的牙科病理（DP）对术后并发症的影响，目前尚未达成共识。本研究的目的是确定肩关节炎置换术前存在 DP 对以下方面的影响：（1）住院时间（LOS），（2）医疗并发症，（3）再入院，（4）与植入物相关的并发症，包括假体关节周围感染（PJI），（5）医疗保健支出。
方法
通过 PearlDiver 数据库对 2010 年至 2020 年的初次肩部关节炎置换术进行了查询。在接受肩部关节炎置换术前有龋齿或牙种植体植入史的患者被视为研究组（n=1419）。无先前 DP 的患者为对照组（n=7062）。通过年龄、性别和合并症，将研究组患者与对照组患者进行 1:5 比例匹配。主要结局包括 LOS、90 天内并发症、再入院、2 年内与植入物相关的并发症以及医疗保健补偿。使用逻辑回归计算并发症和再入院的优势比（OR）。t 检验用于比较 LOS 和成本。p 值＜0.003 被认为具有统计学意义。
结果
两组患者的 LOS（2.17 天与 2.07 天；p=0.071）相似。与对照组相比，有 DP 的患者在 90 天内发生医疗并发症的风险更高（OR：1.74，p＜0.0001），包括心肌梗死（2.2%与 0.8%；OR：2.79，p＜0.0001）、急性肾损伤（8.3%与 4.6%；OR：1.92，p＜0.0001）和肺炎（8.7%与 5.3%；OR：1.72，p＜0.0001）。再入院率（1.97%与 1.54%；p=0.248）相似。与对照组相比，有 DP 的患者在 2 年内发生植入物并发症的风险更高（16.1%与 11.5%；OR：1.38，p=0.0003），包括脱位（6.4%与 4.5%；OR：1.45，p=0.002）和机械松动（4.0%与 2.4%；OR：1.67，p=0.001）；然而，PJI 的发生率相似（2.2%与 1.9%；OR：1.12，p=0.583）。两组患者的医疗保健支出相似（$12611 与 $12059；p=0.075）。
结论
有 DP 的患者在 90 天内发生医疗并发症和 2 年内与植入物相关的并发症的风险更高。两组患者 2 年内的 PJI 发生率相似。这些发现可以帮助肩部外科医生为有相关牙科病史的患者提供相关建议。
证据等级 III：回顾性比较研究。
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