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全髋关节置换术后住院期间心肌梗死的危险因素。

Risk factors for in-patient myocardial infarction following total hip arthroplasty.

作者信息

Mesarick Enzo C, Ratcliff Terrul L, Jose Jonathan, Sambandam Senthil

机构信息

University of Texas Southwestern, Dallas, TX, USA.

Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

出版信息

J Orthop. 2024 Jan 12;51:60-65. doi: 10.1016/j.jor.2024.01.007. eCollection 2024 May.

Abstract

PURPOSE

The aim of this study was to identify potential risk factors for myocardial infarction immediately following total hip arthroplasty.

METHODS

The 2016-2019 Nationwide Inpatient Sample database was used to identify patients who underwent primary total hip arthroplasty (THA) and suffered a myocardial infarction (MI). Patient data including demographics, admission, and comorbidities were recorded. Univariate analysis and subsequent multivariate logistic regression were performed to determine which circumstances affected the odds of MI.

RESULTS

A total of 367,890 patients were identified for THA with 142 of those also having a myocardial infarction. Those who experienced an MI had increased length of stay, total charges, and generally negative dispositions compared to their non-MI counterparts ( < 0.001). Through regression analysis, factors that increased the odds of MI included older age [odds ratio (OR) 1.59, 95 % confidence interval (CI) 1.49-1.70], a female sex (OR 1.46, 95 % CI 1.37-1.55), previous coronary artery bypass graft (OR 1.20, 95 % CI 1.01-1.43), obesity (OR 1.12, 95 % CI 1.04-1.21), colostomy (OR 2.07, 95 % CI 1.21-3.56), and Parkinson's disease (OR 1.48, 95 % CI 1.13-1.95). Factors that decreased that risk included elective admission (OR 0.21, 95 % CI 0.19-0.22) and a tobacco related disorder (OR 0.69, 95 % CI 0.63-0.76).

CONCLUSIONS

Patient risk for myocardial infarction following total hip arthroplasty varies in part based on their background and comorbidities. These findings can be used to better recognize those who should receive further precautions and tailor proper treatment strategies for THA.

摘要

目的

本研究旨在确定全髋关节置换术后立即发生心肌梗死的潜在危险因素。

方法

使用2016 - 2019年全国住院患者样本数据库,识别接受初次全髋关节置换术(THA)并发生心肌梗死(MI)的患者。记录患者的人口统计学、入院情况和合并症数据。进行单因素分析和随后的多因素逻辑回归,以确定哪些情况会影响心肌梗死的发生几率。

结果

共识别出367,890例行全髋关节置换术的患者,其中142例同时发生心肌梗死。与未发生心肌梗死的患者相比,发生心肌梗死的患者住院时间延长、总费用增加,且总体预后较差(<0.001)。通过回归分析,增加心肌梗死发生几率的因素包括年龄较大[比值比(OR)1.59,95%置信区间(CI)1.49 - 1.70]、女性(OR 1.46,95% CI 1.37 - 1.55)、既往冠状动脉搭桥术(OR 1.20,95% CI 1.01 - 1.43)、肥胖(OR 1.12,95% CI 1.04 - 1.21)、结肠造口术(OR 2.07,95% CI 1.21 - 3.56)和帕金森病(OR 1.48,95% CI 1.13 - 1.95)。降低风险的因素包括择期入院(OR 0.21,95% CI 0.19 - 0.22)和烟草相关疾病(OR 0.69,95% CI 0.63 - 0.76)。

结论

全髋关节置换术后患者发生心肌梗死的风险部分取决于其背景和合并症。这些发现可用于更好地识别那些应接受进一步预防措施的患者,并为全髋关节置换术制定适当的治疗策略。

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