Primary and Revision Total Knee Arthroplasty in Patients With Pulmonary Hypertension: High Perioperative Mortality and Complications.
Primary and Revision Total Knee Arthroplasty in Patients With Pulmonary Hypertension: High Perioperative Mortality and Complications.
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DOI：
10.1016/j.arth.2021.07.005
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发表时间：
2021-11
影响因子：
3.5
通讯作者：
Abdel, Matthew P.
中科院分区：
文献类型：
--
作者：
Baker, Courtney E.;Chalmers, Brian P.;Taunton, Michael J.;Kremers, Hilal Maradit;Amundson, Adam W.;Berry, Daniel J.;Abdel, Matthew P.
关键词：
虽然全膝关节置换术（TKA）期间的围手术期医疗管理有所改善，但描述肺动脉高压（HTN）患者结局的文献有限。本研究检查了该医学复杂队列的死亡率、医疗并发症、植入物存活率和临床结局。我们确定了2000-2016年在三级医疗中心接受881例初次TKA和228例翻修TKA的887例肺HTN患者。定期随访患者，直至死亡、翻修手术或末次临床随访。单独审查围手术期医疗并发症。通过计算标准化死亡率比和考克斯比例风险回归模型检查死亡风险。累积发生率分析用于报告死亡、翻修和再手术，死亡是竞争风险。初次和翻修TKA的90天死亡率分别为0.7%和4.8%。与初次（风险比2.54，95% CI：2.12 - 3.05）和翻修（风险比2.16，95% CI：1.78 - 2.62）TKA患者（无肺部HTN）相比，死亡风险高两倍。初次和翻修TKA术后90天内的医疗并发症发生率分别为6.5%和14%。初次手术和翻修手术中任何翻修的10年累积发生率分别为5%和16%。接受初次和翻修TKA的肺HTN患者死亡风险过高，并且在手术后90天内发生医学并发症的几率很高。应考虑风险咨询、医疗优化和转诊至三级中心。ⅳ级
While perioperative medical management during total knee arthroplasty (TKA) has improved, there is limited literature characterizing outcomes of patients with pulmonary hypertension (HTN). This study examined mortality, medical complications, implant survivorship, and clinical outcomes in this medically complex cohort. We identified 887 patients with pulmonary HTN who underwent 881 primary TKAs and 228 revision TKAs from 2000–2016 at a tertiary care center. Patients were followed up at regular intervals until death, revision surgery, or last clinical follow-up. Perioperative medical complications were individually reviewed. The risk of death was examined by calculating standardized mortality ratios and Cox proportional hazards regression models. Cumulative incidence analysis was used for reporting mortality, revision, and reoperation with death as a competing risk. The 90-day mortality was 0.7% and 4.8% for primary and revision TKAs, respectively. The risk of death was two-fold higher compared to primary (hazard ratio 2.54, 95% CI: 2.12 – 3.05) and revision (hazard ratio 2.16, 95% CI: 1.78 – 2.62) TKA patients without pulmonary HTN. Rate of medical complications within 90 days from surgery were 6.5% and 14% in primary and revision TKAs. The 10-year cumulative incidence of any revision was 5% and 16% in primaries and revisions, respectively. Patients with pulmonary HTN undergoing primary and revision TKAs had excess risk of death and experience a high rate of medical complications within 90 days of surgery. Counseling of risks, medical optimization, and referral to tertiary centers should be considered. Level IV
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DOI：
10.1161/circoutcomes.117.003973
发表时间：
2018-02-01
影响因子：
6.9
作者：
Wijeratne, D. Thiwanka;Lajkosz, Katherine;Archer, Stephen L.
通讯作者：
Archer, Stephen L.
影响因子：
24.3
作者：
Meyer, Stephanie;McLaughlin, Vallerie V.;Humbert, Marc
通讯作者：
Humbert, Marc
DOI：
10.1302/0301-620x.94b1.27301
发表时间：
2012-01-01
影响因子：
--
作者：
Poultsides, L. A.;Della Valle, A. Gonzalez;Salvati, E.
通讯作者：
Salvati, E.
影响因子：
2.7
作者：
Menendez, Mariano E.;Memtsoudis, Stavros G.;Della Valle, Alejandro Gonzalez
通讯作者：
Della Valle, Alejandro Gonzalez
影响因子：
5.3
作者：
Gomez, Miguel M.;Tan, Timothy L.;Parvizi, Javad
通讯作者：
Parvizi, Javad