The impact of frailty on outcomes and healthcare resource usage after total joint arthroplasty A POPULATION-BASED COHORT STUDY
The impact of frailty on outcomes and healthcare resource usage after total joint arthroplasty A POPULATION-BASED COHORT STUDY
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DOI：
10.1302/0301-620x.98b6.37124
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发表时间：
2016-06-01
影响因子：
4.6
通讯作者：
Van Walraven, C.
中科院分区：
文献类型：
--
作者：
McIsaac, D. I.;Beaule, P. E.;Van Walraven, C.
全关节置换术（TJA）常用于老年患者。衰弱是一种脆弱性的综合表现，随着年龄的增长变得越来越普遍，并且独立地预测了各种非心脏外科手术后的不良后果和资源使用。我们的目的是评估虚弱对TJA后预后的影响。患者和方法我们在一项基于人群的队列研究中分析了术前虚弱对选择性TJA术后死亡和资源使用的影响，该研究使用了来自加拿大安大略省的相关行政数据。结果12163例年龄在bb0 ~ 65岁的选择性TJA患者中，3023例（2.4%）根据约翰霍普金斯ACG衰弱定义诊断指标虚弱。所有患者随访1年。虚弱的患者有更高的死亡率的风险调整后的一年(危害比为3.03,95%可信区间(CI) 2.62到3.51),较高的进入重症监护(比值比(或)2.52,95%可信区间2.21到2.89),住院时间增加(发病率比1.62,95%可信区间1.59到1.65),较高的放电机构护理(或2.09,95%可信区间1.93到2.25),较高的re-admission(或1.33,95%可信区间1.07到1.66)和增加成本30,90和365天结束。虚弱对全髋关节置换术后的影响大于全膝关节置换术后的影响。
AimsTotal joint arthroplasty (TJA) is commonly performed in elderly patients. Frailty, an aggregate expression of vulnerability, becomes increasingly common with advanced age, and independently predicts adverse outcomes and the use of resources after a variety of non-cardiac surgical procedures. Our aim was to assess the impact of frailty on outcomes after TJA.Patients and MethodsWe analysed the impact of pre-operative frailty on death and the use of resources after elective TJA in a population-based cohort study using linked administrative data from Ontario, Canada.ResultsOf 125 163 patients aged > 65 years having elective TJA, 3023 (2.4%) were frail according to the Johns Hopkins ACG frailty-defining diagnoses indicator. One year follow-up was complete for all patients. Frail patients had a higher adjusted one year risk of mortality (hazard ratio 3.03, 95% confidence interval (CI) 2.62 to 3.51), a higher rate of admission to intensive care (odds ratio (OR) 2.52, 95% CI 2.21 to 2.89), increased length of stay (incidence rate ratio 1.62, 95% CI 1.59 to 1.65), a higher rate of discharge to institutional care (OR 2.09, 95% CI 1.93 to 2.25), a higher rate of re-admission (OR 1.33, 95% CI 1.07 to 1.66) and increased costs at 30, 90 and 365 days post-operatively. Frailty affected outcomes after total hip arthroplasty more than after total knee arthroplasty.