Steadman Philippon Research Institute, Vail, CO, USA.
George Washington School of Medicine and Health Sciences, Washington D.C, USA.
Knee. 2024 Oct;50:88-95. doi: 10.1016/j.knee.2024.07.019. Epub 2024 Aug 10.
There is no clear consensus regarding patient populations at highest risk for complications from simultaneous bilateral total knee arthroplasty (TKA). The purpose of this study was to determine whether the comorbidities comprising the modified Frailty Index (mFI) were correlated with poor outcomes following simultaneous bilateral TKA.
From 2006 to 2019, patients undergoing bilateral TKA aged 50 years or older were identified in a national database. The 5-item mFI was calculated based on the presence of five comorbidities: diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent functional status. Chi-squared and multivariable regression analyses were used to evaluate the association of mFI scores with postoperative complications.
The study analyzed 8,776 patients with an average age of 65 years. After adjustment on multivariable regression analysis, compared to patients with a mFI score of 0, those with a score of 1 had an increased risk of pulmonary complication (OR 3.14; p = 0.011), renal problem (OR 12.86; p = 0.022), sepsis complication (OR 2.82; p = 0.024), postoperative transfusion (OR 1.19; p = 0.012), and non-home discharge (OR 1.17; p = 0.002).Patients with a score of 2 compared to 0 had similar complications when compared. These patients had an increased risk of cardiac complication (OR 4.84; p = 0.009) and prolonged hospital stay (OR 4.06; p < 0.001).
Increased mFI scores were associated with significantly higher complication rates in patients undergoing simultaneous bilateral TKA compared to unilateral TKA. Our results can be used to identify which patients may need a staged bilateral TKA or preoperative optimization to safely undergo a simultaneous bilateral TKA.
III.
目前对于同时行双侧全膝关节置换术（TKA）并发症风险最高的患者人群尚未达成明确共识。本研究旨在确定改良衰弱指数（mFI）所包含的合并症是否与同时行双侧 TKA 后的不良结局相关。
本研究回顾性分析了全国数据库中自 2006 年至 2019 年接受双侧 TKA 的 50 岁及以上患者。基于五种合并症（糖尿病、充血性心力衰竭、高血压、慢性阻塞性肺疾病和依赖的功能状态）的存在，计算 5 项 mFI。采用卡方检验和多变量回归分析评估 mFI 评分与术后并发症之间的相关性。
本研究共纳入 8776 例平均年龄为 65 岁的患者。经多变量回归分析校正后，与 mFI 评分为 0 的患者相比，评分为 1 的患者发生肺部并发症（OR 3.14；p=0.011）、肾脏问题（OR 12.86；p=0.022）、脓毒症并发症（OR 2.82；p=0.024）、术后输血（OR 1.19；p=0.012）和非居家出院（OR 1.17；p=0.002）的风险增加。与评分为 0 的患者相比，评分为 2 的患者具有相似的并发症风险，但心脏并发症（OR 4.84；p=0.009）和住院时间延长（OR 4.06；p<0.001）的风险更高。
与单侧 TKA 相比，mFI 评分增加的患者行同时双侧 TKA 的并发症发生率显著更高。我们的研究结果可用于识别哪些患者可能需要分期双侧 TKA 或术前优化，以安全地行同时双侧 TKA。
III 级。
