Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty.
Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty.
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DOI：
10.1136/ard.2010.148726
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发表时间：
2011-12
影响因子：
27.4
通讯作者：
Lewallen DG
中科院分区：
文献类型：
--
作者：
Singh JA;Jensen MR;Harmsen WS;Gabriel SE;Lewallen DG
研究全髋关节或膝关节置换术（THA/TKA）后90天的心脏和血栓栓塞并发症和全因死亡率。在一项基于人群的队列研究中，研究人员对1994年至2008年期间所有接受过THA或TKA的奥姆斯特德县居民进行了90天的心脏并发症（心肌梗死、心律失常或充血性心力衰竭）、血栓栓塞并发症（深静脉血栓形成（DVT）或肺栓塞（PE））和死亡率的发生率和预测因素进行了评估。在奥姆斯特德县THA和TKA队列中，90天并发症发生率分别为：心脏，15.8%和6.9%；血栓栓塞，分别为4.9%和4.0%；死亡率，分别是0.7%和0.4%。未调整的心脏/血栓栓塞事件的频率因先前各自事件的历史而异。在多变量调整logistic回归分析中，ASA III-IV级（OR, 6.1, 95% CI:1.6, 22.8）和较高的Deyo-Charlson合并症评分（OR, 1.2, 95% CI:1.0,1.4）与无已知心脏事件的患者tha后90天发生心脏事件的几率显著相关。在已知既往有心脏疾病的患者中，ASA III-IV级（OR, 4.4, 95% CI:2.0, 9.9）、男性（OR, 0.5, 95% CI:0.3,0.9）和血栓栓塞性疾病史（OR, 3.2; 95% CI:1.4,7.0）与tha后90天心脏并发症的发生率显著相关。在THA患者中没有发现明显的血栓栓塞预测因素。在没有心脏病史的TKA患者中，年龄为bb0 ~ 65岁（OR, 4.1, 95% CI:1.2, 14.0）， ASA III-IV级（OR, 2.8, 95% CI:1.1,6.8），以及在已知心脏疾病的TKA患者中，ASA III-IV级（OR, 3.2, 95% CI:1.8,5.7）与90天心脏事件的发生率显著相关。在没有血栓栓塞性疾病的TKA患者中，男性（OR, 0.5, 95% CI:0.2,0.9）和较高的Charlson指数（OR, 1.2, 95% CI:1.1,1.3）以及已知血栓栓塞性疾病的患者中，较高的Charlson指数评分（OR, 1.1, 95% CI:1.1,1.4）与90天血栓栓塞事件的发生率相关。年龄较大、合并症较高、ASA等级较高以及既往心脏/血栓栓塞性疾病史与90天心脏和血栓栓塞性并发症的风险增加相关。
Study 90-day cardiac and thromboembolic complications and all-cause mortality following total hip or knee arthroplasty (THA/TKA). In a population-based cohort of all Olmsted County residents who underwent a THA or TKA between 1994 and 2008, we assessed 90-day occurrence and predictors of cardiac complications (myocardial infarction, cardiac arrhythmia or congestive heart failure), thromboembolic complications (deep venous thrombosis (DVT) or pulmonary embolism (PE)) and mortality. Among the Olmsted County THA and TKA cohorts, 90-day complication rates were as follows: cardiac, 15.8% and 6.9%; thromboembolic, 4.9% and 4.0%; and mortality, 0.7% and 0.4%, respectively. Unadjusted frequency of cardiac/thromboembolic events differed by history of prior respective event. In multivariable-adjusted logistic regression analyses, ASA class III–IV (OR, 6.1, 95% CI:1.6, 22.8) and higher Deyo-Charlson comorbidity score (OR, 1.2, 95% CI:1.0,1.4) were significantly associated with odds of 90-day cardiac event post-THA in patients with no known prior cardiac event. In those with known prior cardiac disease, ASA class III–IV (OR, 4.4, 95% CI:2.0, 9.9), male gender (OR, 0.5, 95% CI:0.3,0.9) and history of thromboembolic disease (OR, 3.2; 95% CI:1.4,7.0) were significantly associated with odds of cardiac complication 90-day post-THA. No significant predictors of thromboembolism were found in THA patients. In TKA patients with no prior cardiac history, age >65 years (OR, 4.1, 95% CI:1.2, 14.0), and ASA class III–IV (OR, 2.8, 95% CI:1.1,6.8) and in TKA patients with known cardiac disease, ASA class III–IV (OR, 3.2, 95% CI:1.8,5.7) was significantly associated with odds of 90-day cardiac event. In TKA patients with no prior thromboembolic disease, male gender (OR, 0.5, 95% CI:0.2,0.9) and higher Charlson index (OR, 1.2, 95% CI:1.1,1.3) and in patients with known thromboembolic disease, higher Charlson index score (OR, 1.1, 95% CI:1.1,1.4) was associated with odds of 90-day thromboembolic event. Older age, higher comorbidity, higher ASA class and prior history of cardiac/thromboembolic disease was associated with an increased risk of 90-day cardiac and thromboembolic complications.
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