Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (4): 303-308.doi: 10.24920/003938
全膝关节置换术患者术后严重并发症的危险因素
马璐璐1,虞雪融1,*(
),翁习生2,林进2,金今2,钱文伟2,黄宇光1
- 1中国医学科学院 北京协和医学院 北京协和医院麻醉科, 北京 100730
2中国医学科学院 北京协和医学院 骨科, 北京 100730
-
收稿日期:2021-05-21接受日期:2022-01-11出版日期:2022-12-31发布日期:2022-12-13 -
通讯作者:虞雪融 E-mail:yxr313@aliyun.com
Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty
Lulu Ma1,Xuerong Yu1,*(),Xisheng Weng2,Jin Lin2,Jin Jin2,Wenwei Qian2,Yuguang Huang1
- 1Department of Anesthesiology, Beijing 100730, China
2Department of Orthopedic Surgery;Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
-
Received:2021-05-21Accepted:2022-01-11Published:2022-12-31Online:2022-12-13 -
Contact:Xuerong Yu E-mail:yxr313@aliyun.com
摘要：
目的 术后因严重并发症再次入院是全膝关节置换术后骨科医生最关注的问题之一。本研究分析了全膝关节置换术患者术后严重并发症的危险因素。
方法 我们回顾分析了2,974例于2013年7月至2019年6月在我院行全膝关节置换术患者的病历资料。Clavien-Dindo分级≥Ⅲ级定义为严重并发症。采用二元Logistic回归确定术后严重并发症的危险因素。
结果 全膝关节置换术患者术后并发症的发生率为6.8%，而严重并发症的发生率为2.5%。男性（OR=2.178，95%CI: 1.324~3.585，P = 0.002）、年龄>75岁（OR=1.936，95%CI: 1.155~3.244，P = 0.012）、心律失常（OR=2.913，95%CI: 1.350~6.285，P = 0.006）和脑血管疾病（OR=2.804，95%CI: 1.432~5.489，P = 0.003）是术后严重并发症的危险因素。
结论 对于具有高危因素的患者，如高龄、男性、伴有心律失常和脑血管疾病，应加强术后并发症的监测。
引用本文
Lulu Ma, Xuerong Yu, Xisheng Weng, Jin Lin, Jin Jin, Wenwei Qian, Yuguang Huang. Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty[J].Chinese Medical Sciences Journal, 2022, 37(4): 303-308.
"
| Items | Number (%) |
|---|---|
| Grade | |
| Ⅰ | 58 (28.6) |
| Ⅱ | 72 (35.5) |
| Ⅲ | 63 (31.0) |
| Ⅳ | 9 (4.4) |
| Ⅴ | 1 (0.5) |
| Types | |
| Cardiac | 28 (13.7) |
| Pulmonary | 14 (6.9) |
| Neurologic | 11 (5.4) |
| Thromboembolic | 78 (38.2) |
| Wound or implant related | 49 (24.0) |
| Renal | 15 (7.4) |
| Gastrointestinal | 6 (2.9) |
| Others | 16 (7.8) |
"
| Items | Total (n=2,974) | Severe complication group (n=73) | Non-severe complication group (n=2,901) | χ2 or t value | P value |
|---|---|---|---|---|---|
| Age (yrs, mean±SD) | 66.5±9.0 | 67.8±8.9 | 66.4±9.0 | 0.670 | 0.210 |
| >75 years old [n (%)] | 515 (17.3) | 22 (30.6) | 493 (17.0) | 8.475 | 0.007 |
| Sex [n (%)] | 10.922 | 0.002 | |||
| Female | 2,403 (80.8) | 48 (65.8) | 2,355 (81.2) | ||
| Male | 571 (19.2) | 25 (34.2) | 546 (18.8) | ||
| BMI (kg/m2, mean±SD) | 26.8±3.7 | 27.0±4.2 | 26.8±3.7 | 1.877 | 0.657 |
| ASA [n (%)] | 4.239 | 0.375 | |||
| Ⅰ | 571 (19.2) | 9 (12.3) | 562 (19.4) | ||
| Ⅱ | 2,178 (73.2) | 55 (75.3) | 2,123 (73.2) | ||
| Ⅲ | 225 (7.6) | 9 (12.3) | 216 (7.4) | ||
| NYHA [n (%)] | 3.143 | 0.370 | |||
| Ⅰ | 1,333 (44.8) | 26 (35.6) | 1,307 (45.1) | ||
| Ⅱ | 1,596 (53.7) | 45 (61.6) | 1,551 (53.5) | ||
| Ⅲ | 45 (1.5) | 2 (2.7) | 43 (1.5) | ||
| Comorbidity disease [n (%)] | |||||
| Hypertension | 1,683 (56.6) | 40 (54.8) | 1,643 (56.6) | 0.098 | 0.811 |
| Coronary artery disease | 353 (11.9) | 7 (9.6) | 346 (11.9) | 0.372 | 0.713 |
| Arrythmia | 120 (4) | 8 (11.1) | 112 (3.9) | 9.265 | 0.008 |
| Cerebrovascular disease | 168 (5.6) | 11 (15.1) | 157 (5.4) | 12.944 | 0.002 |
| Chronic kidney disease | 152 (5.1) | 5 (6.8) | 147 (5.1) | 0.466 | 0.421 |
| Diabetes mellitus | 556 (18.7) | 15 (20.5) | 541 (18.6) | 0.168 | 0.650 |
| COPD | 56 (1.9) | 1 (1.4) | 55 (1.9) | 0.107 | 1.000 |
| Smoking [n (%)] | 54 (1.8) | 1 (1.4) | 53 (1.8) | 0.903 | 1.000 |
| Diagnosis [n (%)] | 0.134 | 0.645 | |||
| Osteoarthritis | 2,762 (92.9) | 67 (91.8) | 2,695 (92.9) | ||
| Others | 212 (7.1) | 6 (8.2) | 206 (7.1) |
"
| Items | Total (n=2,974) | Severe complication group (n=73) | Non-severe complication group (n=2,901) | χ2 or t value | P value |
|---|---|---|---|---|---|
| Type of anesthesia [n (%)] | 0.186 | 0.911 | |||
| General anesthesia | 2,812 (94.6) | 69 (94.5) | 2,743 (94.6) | ||
| Spinal or spinal combined with epidural | 155 (5.2) | 4 (5.5) | 151 (5.2) | ||
| Conversion to general anesthesia | 7 (0.2) | 0 | 7 (0.2) | ||
| Type of surgery [n (%)] | 0.013 | 0.901 | |||
| Unilateral total knee arthroplasty | 1,974 (66.4) | 48 (65.8) | 1,926 (66.4) | ||
| Bilateral total knee arthroplasty | 1,000 (33.6) | 25 (34.2) | 975 (33.6) | ||
| Length of anesthesia (min, mean±SD) | 163.1±59.1 | 164.4±57.7 | 163.1±59.1 | 0.002 | 0.840 |
| Length of operation (min, mean±SD) | 124.2±55.1 | 125.6±55.6 | 124.1±55.1 | 0.084 | 0.803 |
| Length of tourniquet application (min, mean±SD) | 104.1±49.2 | 103.6±52.9 | 104.1±49.1 | 0.664 | 0.912 |
| Preoperative hemoglobin (g/L, mean±SD) | 132.4±24.8 | 132.6±12.9 | 132.4±25.0 | 0.001 | 0.928 |
| Preoperative anemia [n (%)] | 474 (15.9) | 11 (15.1) | 463 (16.0) | 0.042 | 1.000 |
| Perioperative transfusion [n (%)] | 309 (10.4) | 16 (21.9) | 293 (10.1) | 10.682 | 0.003 |
| Length of hospital stay [d, median (range)] | 7 (4, 9) | 14 (8.5, 18.5) | 6 (4, 8) | 125.211 | <0.001 |
| ICU admission post-operatively [n (%)] | 30 (1.0) | 9 (12.3) | 21 (0.7) | 96.036 | <0.001 |
"
| Variables | B | Standard error | Wald χ2 | P value | OR | 95%CI |
|---|---|---|---|---|---|---|
| Male | 0.779 | 0.254 | 9.383 | 0.002 | 2.178 | 1.324-3.585 |
| ≥75 years old | 0.661 | 0.263 | 6.286 | 0.012 | 1.936 | 1.155-3.244 |
| Arrhythmia | 1.069 | 0.392 | 7.430 | 0.006 | 2.913 | 1.350-6.285 |
| Cerebrovascular diseases | 1.031 | 0.343 | 9.048 | 0.003 | 2.804 | 1.432-5.489 |
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