Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12Th Wulumuqi Middle Road, Shanghai, 200040, Jing'an District, China.
Clin Rheumatol. 2024 Oct;43(10):3127-3137. doi: 10.1007/s10067-024-07098-w. Epub 2024 Aug 13.
Systemic lupus erythematosus (SLE) can adversely affect surgical outcomes, and the impact on revision total knee arthroplasty (TKA) outcomes is unclear. This study aimed to explore the impact of SLE on in-patient outcomes of revision TKA. The Nationwide Inpatient Sample (NIS) database from 2005 to 2018 was searched for patients aged ≥ 18 years old who received revision TKA. Patients with and without SLE were propensity score matched (PSM) at a 1:4 ratio. Associations between SLE and in-hospital outcomes were examined using regression analyses. The study included 133,054 patients, with 794 having SLE. After 1:4 PSM, data of 3,970 patients were analyzed (SLE, 794; non-SLE, 3,176). Multivariate-adjusted analyses revealed that SLE patients had a significantly higher risk of postoperative complications (adjusted odds ratio [aOR] = 1.23, 95% confidence interval [CI]: 1.05-1.44, p = 0.011), non-routine discharge (aOR = 1.22, 95% CI: 1.02-1.46, p = 0.028), major blood loss (aOR = 1.19), respiratory failure/mechanical ventilation (aOR = 1.79), acute kidney injury (AKI) (aOR = 1.47), and wound dehiscence (aOR = 2.09). SLE patients also had a longer length of hospital stay (aBeta = 0.31) and greater total hospital costs (aBeta = 6.35) compared to non-SLE patients. Among those with aseptic failure, SLE patients had a significantly higher risk of postoperative complications (aOR = 1.23) and non-routine discharge (aOR = 1.36). SLE is independently associated with worse in-hospital outcomes in patients undergoing revision TKA. This study highlights the importance of heightened vigilance and tailored perioperative management for patients undergoing major surgeries in the background of SLE. Key Points • SLE significantly increases the risk of non-routine discharge, major blood loss, respiratory failure, acute kidney injury, and wound dehiscence, in patients undergoing aseptic and septic revision TKA. • Patients with SLE experience longer hospital stays and higher hospital costs compared to those without SLE. • The study's findings highlight the necessity for healthcare providers to consider the presence of SLE as a critical factor in preoperative planning and postoperative care to improve outcomes in revision TKA patients.
系统性红斑狼疮（SLE）会对手术结果产生不利影响，但其对翻修全膝关节置换术（TKA）结果的影响尚不清楚。本研究旨在探讨 SLE 对翻修 TKA 住院患者结局的影响。从 2005 年至 2018 年，检索了国家住院患者样本（NIS）数据库中年龄≥18 岁接受翻修 TKA 的患者。采用倾向评分匹配（PSM）将 SLE 患者和非 SLE 患者按 1:4 的比例进行匹配。使用回归分析检查 SLE 与住院期间结局的相关性。该研究纳入了 133054 例患者，其中 794 例患有 SLE。1:4 PSM 后，分析了 3970 例患者的数据（SLE 794 例，非 SLE 3176 例）。多变量调整分析显示，SLE 患者术后并发症（调整优势比[aOR]1.23，95%置信区间[CI]：1.05-1.44，p=0.011）、非常规出院（aOR 1.22，95%CI：1.02-1.46，p=0.028）、大量失血（aOR 1.19）、呼吸衰竭/机械通气（aOR 1.79）、急性肾损伤（AKI）（aOR 1.47）和伤口裂开（aOR 2.09）的风险显著增加。与非 SLE 患者相比，SLE 患者的住院时间更长（aBeta=0.31），总住院费用更高（aBeta=6.35）。在无菌性失败的患者中，SLE 患者术后并发症（aOR 1.23）和非常规出院（aOR 1.36）的风险显著增加。SLE 与翻修 TKA 患者的住院期间不良结局独立相关。本研究强调了对于在 SLE 背景下接受大手术的患者，需要保持高度警惕并进行个体化围手术期管理。关键点 • SLE 显著增加无菌性和感染性翻修 TKA 患者非常规出院、大量失血、呼吸衰竭、急性肾损伤和伤口裂开的风险。 • SLE 患者的住院时间和住院费用均高于非 SLE 患者。 • 本研究结果强调了医疗保健提供者在术前计划和术后护理中考虑 SLE 存在的必要性，以改善翻修 TKA 患者的结局。
