Long-Term Mortality Trends After Total Hip and Knee Arthroplasties: A Population-Based Study
Long-Term Mortality Trends After Total Hip and Knee Arthroplasties: A Population-Based Study
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DOI：
10.1016/j.arth.2015.12.010
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发表时间：
2016-06-01
影响因子：
3.5
通讯作者：
Berry, Daniel J.
中科院分区：
文献类型：
--
作者：
Kremers, Hilal Maradit;Larson, Dirk R.;Berry, Daniel J.
背景资料：全髋关节和膝关节置换术后的死亡率低于一般人群，但尚不清楚手术类型、人口统计学和日历年是否存在差异。我们的目的是评估全髋关节和膝关节arthroplasty.Methods患者的长期死亡率的趋势和决定因素：使用历史队列研究设计，我们被动地随访了以人群为基础的队列全髋关节和全膝关节置换术患者退行性关节炎谁接受手术1969年1月1日至2008年12月31日。患者随访至死亡或2014年8月31日。使用标准化死亡率（SMR）比较观察到的生存率和预期生存率。采用Poisson回归模型分析手术类型、年龄、性别、历年和手术后时间的相对死亡率模式。（SMR：0.82，95% CI：0.76-0.88）和全膝关节置换术（SMR = 0.80，95% CI：0.75-0.86）。尽管手术前8年的相对死亡率较低，但我们观察到全膝关节置换术后15年的相对死亡率恶化。短期和长期的死亡率提高了日历时间，并改善发生在全膝关节置换术比全髋关节置换术前约十年。结论：全髋关节和全膝关节置换术后的生存率优于一般人群手术后约8年。长期趋势是令人鼓舞的，并表明这两种程序后的生存率近年来一直在进一步提高。(C)2015爱思唯尔公司All rights reserved.
Background: Mortality after total hip and knee arthroplasty is lower than that in the general population, but it is unknown whether there are differences by surgery type, demographics, and calendar year. Our objective was to evaluate trends and determinants of long-term mortality among patients with total hip and knee arthroplasties.Methods: Using a historical cohort study design, we passively followed up population-based cohorts of total hip and total knee arthroplasty patients with degenerative arthritis who underwent surgery between January 1, 1969 and December 31, 2008. Patients were followed up until death or August 31, 2014. Observed and expected survival was compared using standardized mortality ratios (SMRs). Poisson regression models were used to examine relative mortality patterns by surgery type, age, sex, calendar year, and time since surgery.Results: The overall age-and sex-adjusted mortality was significantly lower than that in the general population after both total hip (SMR: 0.82, 95% CI: 0.76-0.88) and total knee (SMR = 0.80, 95% CI: 0.75-0.86) arthroplasties. Despite the low relative mortality within the first 8 years of surgery, we observed a worsening of relative mortality beyond 15 years after total knee arthroplasty surgery. Both short-and long-term mortality improved over calendar time, and the improvement occurred about a decade earlier in total knee arthroplasty than in total hip arthroplasty.Conclusion: Survival after total hip and total knee arthroplasties is better than that in the general population for about 8 years after surgery. Secular trends are encouraging and suggest that survival after both procedures has been improving even further in recent years. (C) 2015 Elsevier Inc. All rights reserved.