A nationwide analysis of risk factors for in-hospital myocardial infarction after total joint arthroplasty
A nationwide analysis of risk factors for in-hospital myocardial infarction after total joint arthroplasty
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DOI：
10.1007/s00264-014-2502-z
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发表时间：
2015-04-01
影响因子：
2.7
通讯作者：
Della Valle, Alejandro Gonzalez
中科院分区：
文献类型：
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作者：
Menendez, Mariano E.;Memtsoudis, Stavros G.;Della Valle, Alejandro Gonzalez
尽管急性心肌梗死（AMI）是一种令人恐惧的医学并发症，也是目前全髋关节置换术（THA/TKA）后死亡的主要原因，但对其围手术期相关因素知之甚少。方法回顾性队列研究的数据来自2008-2011年全国住院患者样本。采用多变量logistic回归模型确定与THA/TKA术后住院AMI发生相关的围手术期因素。结果估计有3,096,791例手术被确定。THA和TKA围手术期AMI发生率分别为0.25%和0.18%。AMI患者的合并症负担明显加重，围手术期死亡率较高，住院时间较长，并发症发生率较高。AMI发生的独立危险因素包括高龄、男性[比值比（OR） 1.4, 95%可信区间（CI） 1.4-1.5]、THA手术（OR 1.3, 95% CI 1.3-1.4）、家庭收入低（OR 1.3, 95% CI 1.2-1.4）、心脏病史(冠心病：OR 4.9, 95% CI 4.6-5.2；充血性心力衰竭：OR 2.6, 95% CI 2.4-2.8；瓣膜病:或1.2,95%置信区间1.1 - -1.3)、糖尿病(或1.1,95%可信区间1.1 - -1.2),肺循环障碍(或1.4,95%可信区间1.2 - -1.6),脑血管疾病(或2.3,95% CI 2.0 - -2.6)、外周血管疾病(或1.5,95%可信区间1.4 - -1.7),凝血障碍(或1.4,95%可信区间1.2 - -1.5),艾滋病/艾滋病毒感染(或7.9,95%可信区间4.5 - -13.9),缺乏贫血(或1.4,95%可信区间1.3 - -1.5),液体和电解质紊乱(或1.9,95% CI 1.8 - -2.0)和伴随的术后并发症的发生。结论：我们的研究结果可用于更好地识别AMI高危患者，并制定旨在降低其发病率的策略，从而提高医院效率和护理质量。
Purpose Despite acute myocardial infarction (AMI) being a feared medical complication and currently a major cause of death after total hip and knee arthroplasty (THA/TKA), little is known about its peri-operative associated factors.Methods Data for this retrospective cohort study were extracted from the Nationwide Inpatient Sample for 2008-2011. Multivariate logistic regression modeling was performed to determine peri-operative factors associated with the development of inpatient AMI following THA/TKA.Results An estimated 3,096,791 procedures were identified. Perioperative AMI rates were 0.25 % for THA and 0.18 % for TKA. Patients with AMI had significantly greater comorbidity burden, higher peri-operative mortality rates, longer length of hospital stay and increased complication rates. Independent risk factors for the development of AMI comprised advance age, male gender [odds ratio (OR) 1.4, 95 % confidence interval (CI) 1.4-1.5], THA surgery (OR 1.3, 95 % CI 1.3-1.4), low household income (OR 1.3, 95 % CI 1.2-1.4), history of cardiac disease (coronary artery disease: OR 4.9, 95 % CI 4.6-5.2; congestive heart failure: OR 2.6, 95 % CI 2.4-2.8; valvular disease: OR 1.2, 95 % CI 1.1-1.3), diabetes (OR 1.1, 95 % CI 1.1-1.2), pulmonary circulation disorders (OR 1.4, 95 % CI 1.2-1.6), cerebrovascular disease (OR 2.3, 95 % CI 2.0-2.6), peripheral vascular disorders (OR 1.5, 95 % CI 1.4-1.7), coagulopathy (OR 1.4, 95 % CI 1.2-1.5), AIDS/HIV infection (OR 7.9, 95 % CI 4.5-13.9), deficiency anaemia (OR 1.4, 95 % CI 1.3-1.5), fluid and electrolyte disorders (OR 1.9, 95 % CI 1.8-2.0) and the occurrence of concomitant postoperative complications.Conclusion Our findings can be used to better identify patients at high risk of AMI and to develop strategies aimed at diminishing its incidence, which could in turn translate to improved hospital efficiency and quality of care.