Korbal Tara, Branstetter Iv Robert, Cable Matthew, Jones Deryk, Shi Lizheng, Hall Lauren, Chapple Andrew
LSUHSC School of Medicine, New Orleans, LA, USA.
LSUHSC Department of Orthopaedic Surgery, New Orleans, LA, USA.
J Orthop. 2024 Nov 29;65:8-14. doi: 10.1016/j.jor.2024.11.027. eCollection 2025 Jul.
AIMS & OBJECTIVES: The primary objective of this study is to determine whether an active cancer diagnosis results in an increased risk of perioperative TJA complications and postoperative mortality. The secondary objective is to analyze the effects of demographic factors on perioperative complication rates in cancer patients undergoing TJA.
MATERIALS & METHODS: Patients with active cancer diagnoses undergoing total joint arthroplasty from 2014 to 2020 were included in this retrospective analysis. Patient data was obtained through ReachNet, which consisted of data from the University Medical Center, Tulane University Medical Center, Ochsner Health System, and Baylor Scott & White Health. ICD-9/10 codes were tagged for active cancer diagnoses within 365 days before surgery or 30 days after surgery to establish our active cancer population. Acute surgical complications within 30 days were identified by ICD codes.
Patient demographics included predominantly male (51.5 %), white (83 %), and non-Hispanic (96.5 %) patients followed by black individuals (15.9 %) with 47.5 % of patients being smokers. Cancer patients did have a higher acute complication rate (2.6 % vs 1.7 %), but this difference was not significant (p = .139). This difference was higher but also not significant after adjustment (aOR = 1.32, 95 % CI = 0.71-2.43, p = .377). After adjustment, increased Charlson Comorbidity Index (CCI), white race and non-elective surgery were significant contributors to complication risk. Complication rates decreased significantly with year. Nonelective surgeries were also associated with higher complication rates (8.2 % vs. 1.8 %, p = .014).
Patients with active cancer diagnoses demonstrated higher unadjusted rates of TJA acute surgical complications and increased adjusted CCI when compared to non-cancer patients. Identifying risk factors and demographics correlated with increased perioperative complications may provide physicians with necessary information to avoid negative TJA outcomes in cancer patients.
本研究的主要目的是确定活跃癌症诊断是否会导致全关节置换术（TJA）围手术期并发症和术后死亡率增加。次要目的是分析人口统计学因素对接受TJA的癌症患者围手术期并发症发生率的影响。
本回顾性分析纳入了2014年至2020年期间接受全关节置换术且有活跃癌症诊断的患者。患者数据通过ReachNet获得，该数据库包含来自大学医学中心、杜兰大学医学中心、奥克施纳健康系统以及贝勒·斯科特与怀特健康中心的数据。通过手术前365天内或手术后30天内的ICD - 9/10编码标记活跃癌症诊断，以确定我们的活跃癌症患者群体。通过ICD编码识别30天内的急性手术并发症。
患者人口统计学特征主要包括男性（51.5%）、白人（83%）和非西班牙裔（96.5%）患者，其次是黑人个体（15.9%），47.5%的患者为吸烟者。癌症患者的急性并发症发生率确实较高（2.6%对1.7%），但这种差异不显著（p = 0.139）。调整后这种差异更高但仍不显著（调整后比值比[aOR] = 1.32，95%置信区间[CI] = 0.71 - 2.43，p = 0.377）。调整后，查尔森合并症指数（CCI）增加、白人种族和非择期手术是并发症风险的重要因素。并发症发生率随年份显著下降。非择期手术也与较高的并发症发生率相关（8.2%对1.8%，p = 0.014）。
与非癌症患者相比，有活跃癌症诊断的患者表现出更高的未调整TJA急性手术并发症发生率和调整后的CCI增加。识别与围手术期并发症增加相关的风险因素和人口统计学特征可能为医生提供必要信息，以避免癌症患者出现不良的TJA结果。
