Xu Dongdong, Ding Cheng, Cheng Tao, Yang Chao, Zhang Xianlong
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Bone Joint Res. 2023 Jun 1;12(6):362-371. doi: 10.1302/2046-3758.126.BJR-2022-0394.R1.
The present study aimed to investigate whether patients with inflammatory bowel disease (IBD) undergoing joint arthroplasty have a higher incidence of adverse outcomes than those without IBD.
A comprehensive literature search was conducted to identify eligible studies reporting postoperative outcomes in IBD patients undergoing joint arthroplasty. The primary outcomes included postoperative complications, while the secondary outcomes included unplanned readmission, length of stay (LOS), joint reoperation/implant revision, and cost of care. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model when heterogeneity was substantial.
Eight retrospective studies involving 29,738 patients with IBD were included. Compared with non-IBD controls, patients with IBD were significantly more likely to have overall complications (OR 2.11 (95% CI 1.67 to 2.66), p < 0.001), medical complications (OR 2.15 (95% CI 1.73 to 2.68), p < 0.001), surgical complications (OR 1.43 (95% CI 1.21 to 1.70), p < 0.001), and 90-day readmissions (OR 1.42 (95% CI 1.23 to 1.65), p < 0.001). The presence of IBD was positively associated with the development of venous thromboembolism (OR 1.60 (95% CI 1.30 to 1.97), p < 0.001) and postoperative infection (OR 1.95 (95% CI 1.51 to 2.51), p < 0.001). In addition, patients with IBD tended to experience longer LOS and higher costs of care.
The findings suggest that IBD is associated with an increased risk of postoperative complications and readmission after joint arthroplasty, resulting in longer hospital stay and greater financial burden. Surgeons should inform their patients of the possibility of adverse outcomes prior to surgery and make appropriate risk adjustments to minimize potential complications.
本研究旨在调查接受关节置换术的炎症性肠病(IBD)患者与未患IBD的患者相比,不良结局的发生率是否更高。
进行了全面的文献检索,以确定报告接受关节置换术的IBD患者术后结局的合格研究。主要结局包括术后并发症,次要结局包括计划外再入院、住院时间(LOS)、关节再次手术/植入物翻修以及护理费用。当异质性较大时,使用随机效应模型计算合并比值比(OR)和95%置信区间(CI)。
纳入了八项涉及29738例IBD患者的回顾性研究。与非IBD对照组相比,IBD患者发生总体并发症(OR 2.11(95%CI 1.67至2.66),p<0.001)、医疗并发症(OR 2.15(95%CI 1.73至2.68),p<0.001)、手术并发症(OR 1.43(95%CI 1.21至1.70),p<0.001)和90天再入院(OR 1.42(95%CI 1.23至1.65),p<0.001)的可能性显著更高。IBD的存在与静脉血栓栓塞的发生(OR 1.60(95%CI 1.30至1.97),p<0.001)和术后感染(OR 1.95(95%CI 1.51至2.51),p<0.001)呈正相关。此外,IBD患者往往住院时间更长,护理费用更高。
研究结果表明,IBD与关节置换术后并发症和再入院风险增加相关,导致住院时间延长和经济负担加重。外科医生应在手术前告知患者不良结局的可能性,并进行适当的风险调整以尽量减少潜在并发症。