From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
J Am Acad Orthop Surg. 2024 Jun 15;32(12):543-549. doi: 10.5435/JAAOS-D-23-01142. Epub 2024 Apr 18.
Total knee arthroplasty (TKA) is a common procedure for which patient factors are known to affect perioperative outcomes. Asthma has not been specifically considered in this regard, although it is the most common inflammatory airway disease and predisposes to osteoarthritis.
Adult patients undergoing TKA were identified from 2015 to 2021-Q3 M157 PearlDiver data sets. Asthma patients were matched to those without 1:1 based on age, sex, and Elixhauser Comorbidity Index (ECI). The incidence of 90-day adverse events and 5-year revisions were compared using multivariable logistic regression ( P < 0.0023). The matched asthma group was then stratified based on disease severity for analysis of 90-day aggregated (any, severe, and minor) adverse events.
Among 721,686 TKA patients, asthma was noted for 76,125 (10.5%). Multivariable analysis revealed that patients with asthma were at increased odds of multiple 90-day pulmonary, non-pulmonary, and aggregated adverse events, as well as emergency department visits. Furthermore, patients with asthma had 1.17 times greater odds of 5-year revisions ( P < 0.0001). Upon secondary analysis stratifying asthma by severity, patients with all severity levels of asthma showed elevated odds of adverse events after TKA. These associations increased in odds with increasing severity of asthma.
Over one-tenth of patients undergoing TKA were identified as having asthma, and these patients were at greater odds of numerous pulmonary and non-pulmonary adverse events (a trend that increased with asthma severity), as well as 5-year revisions. Clearly, patients with asthma need specific risk mitigation strategies when considering TKA.
III.
全膝关节置换术（TKA）是一种常见的手术，患者因素已知会影响围手术期的结果。虽然哮喘是最常见的炎症性气道疾病，且易患骨关节炎，但在这方面尚未专门考虑哮喘。
从 2015 年至 2021 年第三季度的 PearlDiver M157 数据集中确定接受 TKA 的成年患者。根据年龄、性别和 Elixhauser 合并症指数（ECI），对哮喘患者与无哮喘患者进行 1:1 匹配。使用多变量逻辑回归比较 90 天不良事件和 5 年翻修的发生率（P<0.0023）。然后，根据疾病严重程度对匹配的哮喘组进行分层，以分析 90 天聚合（任何、严重和轻微）不良事件。
在 721686 例 TKA 患者中，哮喘患者为 76125 例（10.5%）。多变量分析显示，哮喘患者发生多种 90 天肺部、非肺部和聚合不良事件以及急诊就诊的可能性更高。此外，哮喘患者的 5 年翻修几率增加 1.17 倍（P<0.0001）。进一步对哮喘严重程度进行二次分析，发现所有严重程度的哮喘患者在接受 TKA 后发生不良事件的几率均升高。随着哮喘严重程度的增加，这些关联的几率也随之增加。
在接受 TKA 的患者中，超过十分之一的患者被诊断为患有哮喘，这些患者发生多种肺部和非肺部不良事件（这种趋势随着哮喘严重程度的增加而增加）以及 5 年翻修的几率更高。显然，在考虑 TKA 时，哮喘患者需要特定的风险缓解策略。
III。
