Department of Orthopedics, University of Calgary, Calgary, AB, Canada.
Resident-Henry Ford Hospital, Jackson, MI, USA.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5261-5268. doi: 10.1007/s00402-022-04762-1. Epub 2023 Jan 2.
In view of the vaso-occlusive pathophysiology affecting osseous micro-circulation, sickle cell disease (SCD) is well known to present with diverse skeletal and arthritic manifestations. With prolonged life-expectancy over the past decades, there has been a progressive increase in the proportion of SCD patients requiring joint reconstructions. Owing to the paucity of evidence in the literature, the post-operative complication rates and outcome in these patients following total knee arthroplasty (TKA) are still largely unknown.
Based on the National Inpatient Sample (NIS) database (using ICD-10 CMP code), patients who underwent TKA between 2016 and 2019 were identified. The cohort were classified into two groups: A-those with SCD; and B-those without. The data on patients' demographics, co-morbidities, details regarding hospital stay including expenditure incurred, and complications were analyzed and compared.
Overall, 558,361 patients underwent unilateral, primary TKA; among whom, 493 (0.1%) were known cases of SCD (group A). Group A included a significantly greater proportion of younger (60.14 ± 10.87 vs 66.72 ± 9.50 years; p < 0.001), male (77.3 vs 61.5%; p < 0.001); and African-American (88.2 vs 8.3%B; p < 0.001) patients, in comparison with group B. Group A patients were also at a significantly higher risk for longer duration of peri-operative hospital stay (p < 0.001), greater health-care costs incurred (p < 0.001), and greater need for alternative step-down health-care facilities (p < 0.001) following discharge. Among the SCD patients, 24.7%, 20.9% and 24.9% developed acute chest syndrome, pain crisis and splenic sequestration crisis, respectively during the peri-operative period. Group A patients had a statistically greater incidence of acute renal failure (ARF; p = 0.014), need for blood transfusion (p < 0.001) and deep vein thrombosis (DVT; p = 0.03) during the early admission period.
The presence of SCD substantially lengthens the duration of hospital stay and enhances health care-associated expenditure in patients undergoing TKA. SCD patients are at significantly higher risk for systemic complications including acute chest syndrome, pain crisis, splenic sequestration crisis, acute renal failure, higher need for blood transfusions and deep venous thrombosis during the initial peri-operative period following TKA.
鉴于影响骨骼微循环的血管阻塞性病理生理学，镰状细胞病（SCD）众所周知会表现出多种骨骼和关节表现。在过去几十年中，预期寿命延长，需要进行关节重建的 SCD 患者比例逐渐增加。由于文献中证据不足，这些患者在接受全膝关节置换术（TKA）后的术后并发症发生率和结果在很大程度上仍然未知。
基于国家住院患者样本（NIS）数据库（使用 ICD-10 CMP 代码），确定了 2016 年至 2019 年间接受 TKA 的患者。将队列分为两组：A-患有 SCD 的患者；B-无 SCD 的患者。分析和比较了患者人口统计学、合并症、住院时间（包括所产生的费用）以及并发症等方面的数据。
总体而言，558361 例患者接受了单侧初次 TKA；其中，493 例（0.1%）为已知的 SCD 病例（A 组）。A 组包括比例显著更高的年轻患者（60.14±10.87 岁 vs 66.72±9.50 岁；p<0.001）、男性（77.3% vs 61.5%；p<0.001）和非裔美国人（88.2% vs 8.3%B；p<0.001）患者。与 B 组相比。与 B 组相比，A 组患者的围手术期住院时间更长（p<0.001），医疗费用更高（p<0.001），出院后更需要替代的降阶梯医疗设施（p<0.001）。在 SCD 患者中，分别有 24.7%、20.9%和 24.9%在围手术期发生急性胸部综合征、疼痛危象和脾隔离危象。A 组患者发生急性肾衰竭（ARF；p=0.014）、需要输血（p<0.001）和深静脉血栓形成（DVT；p=0.03）的发生率显著更高。
SCD 的存在显著延长了 TKA 患者的住院时间，并增加了与医疗保健相关的支出。SCD 患者在接受 TKA 后的初始围手术期内，发生急性胸部综合征、疼痛危象、脾隔离危象、急性肾衰竭、更需要输血和深静脉血栓形成等全身并发症的风险显著更高。
