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Pulmonary Complications After Hip and Knee Arthroplasty in the United States, 2004-2014.

美国髋关节和膝关节置换术后肺部并发症,2004-2014。

  • 影响因子:2.27
  • DOI:10.1213/ANE.0000000000004265
  • 作者列表:"Malcolm TL","Knezevic NN","Zouki CC","Tharian AR
  • 发表时间:2020-04-01
Abstract

BACKGROUND:Pulmonary complications after total joint arthroplasty (TJA) are uncommon but have significant cost impact. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are 2 of the 5 top procedures requiring inpatient stay within the United States. Subsequent pulmonary complications therefore may impose substantial cost burden for US health care. The purpose of this study was to describe the incidence, risk factors, and clinical implications of pulmonary complications (ie, pneumonia, respiratory failure, pulmonary embolism [PE], and aspiration) after TJA in the United States. METHODS:The National Inpatient Sample (NIS) was queried for all patients undergoing primary, elective THA and TKA between years 2004 and 2014. Pulmonary complications were defined as the occurrence of pneumonia, respiratory failure, PE, or aspiration after TJA. Demographic and clinical characteristics, inpatient cost, length of stay (LOS), and mortality were compared between patients with and without documented perioperative pulmonary complications. Given the stratified nature of the NIS database, estimates of incidence throughout the United States were made with application of trend weights to observed database frequencies. Analyses of estimated annual complication rates were made using χ tests. RESULTS:Between 2004 and 2014, an estimated 2,679,351 patients underwent elective primary THA. A total of 5,527,205 patients were estimated to have undergone elective primary TKA. THA 1.42% (95% CI, 1.37%-1.47%) and 1.71% (95% CI, 1.66%-1.76%) of TKA procedures were complicated by pneumonia, respiratory failure, PE, or aspiration. During this time, the incidence of perioperative pulmonary complications decreased from 1.57% (95% CI, 1.41%-1.73%) to 1.01% (95% CI, 0.92%-1.10%) after THA (P < .0001) and from 2.03% (95% CI, 1.88%-2.18%) to 1.33% (95% CI, 1.25%-1.42%) after TKA (P < .0001). The adjusted odds ratio (aOR) of experiencing a pulmonary complication was highest among patients with history of significant weight loss (aOR = 4.77; 99.9% CI, 3.97-5.73), fluid/electrolyte disorders (aOR = 3.33; 99.9% CI, 3.11-3.56), congestive heart failure (CHF; aOR = 3.32; 99.9% CI, 3.07-3.58), preexisting paralytic condition (aOR = 2.03; 99.9% CI, 1.57-2.61), and human immunodeficiency virus infection (aOR = 2.00; 99.9% CI, 1.06-3.78). Perioperative pulmonary complications were associated with increased LOS (THA = 3.03 days; 99.9% CI, 2.76-3.31; TKA = +2.72 days; 99.9% CI, 2.58-2.86), increased hospital costs (THA = +9163 US dollars; 99.9% CI, 8054-10,272; TKA = +7257 US dollars; 99.9% CI, 6650-7865), and increased mortality (THA: aOR = 121; 99.9% CI, 78-187; TKA: aOR = 150; 95% CI, 97-233). CONCLUSIONS:Despite a decline in overall incidence, perioperative pulmonary complications represent a significant potential source of perioperative morbidity and mortality. The current study highlights potential risk factors for pulmonary complications. Recognition of these factors may help to better stratify patients and mitigate risk of potential complications. This is particularly true of respiratory failure as it is associated with the high increases in resource utilization and mortality in this group.

摘要

背景: 全关节置换 (TJA) 术后肺部并发症并不常见,但对成本影响很大。全髋关节置换术 (THA) 和全膝关节置换术 (TKA) 是需要在美国住院的 5 个顶级手术中的 2 个。因此,随后的肺部并发症可能对美国医疗保健造成巨大的成本负担。本研究的目的是描述肺部并发症 (如肺炎、呼吸衰竭、肺栓塞 [PE] 和误吸) 的发生率、危险因素和临床意义在美国TJA之后。 方法: 对 2004 年至 2014 年间接受原发性、选择性THA和TKA的所有患者进行全国住院样本 (NIS) 查询。肺部并发症定义为TJA后发生肺炎、呼吸衰竭、PE或误吸。比较有和无记录的围手术期肺部并发症患者的人口统计学和临床特征、住院费用、住院时间 (LOS) 和死亡率。鉴于NIS数据库的分层性质,通过对观察到的数据库频率应用趋势权重来估计整个美国的发病率。使用 χ 检验对估计的年度并发症发生率进行分析。 结果: 在 2004 至 2014 之间,估计有 2,679,351 名患者接受了选择性初次THA。估计共有 5,527,205 名患者接受了选择性原发性TKA。THA 1.42% (95% CI,1.37%-1.47%) 和 1.71% (95% CI,1.66%-1.76%) 的TKA手术并发肺炎、呼吸衰竭、PE或误吸。在此期间,THA术后围手术期肺部并发症的发生率从 1.57% (95% CI,1.41%-1.73%) 降至 1.01% (95% CI,0.92%-1.10%) (P < .0001) 从 2.03% (95% CI,1.88%-2.18%) 到TKA后的 1.33% (95% CI,1.25%-1.42%) (P <.0001)。经历肺部并发症的校正比值比 (aOR) 在有显著体重减轻史的患者中最高 (aOR = 4.77; 99.9% CI,3.97-5.73),液体/电解质紊乱 (aOR = 3.33; 99.9% CI,3.11-3.56),充血性心力衰竭 (CHF; aOR = 3.32; 99.9% CI,3.07-3.58),预先存在的麻痹状况 (aOR = 2.03; 99.9% CI,1.57-2.61),与人体免疫机能丧失病毒感染 (aOR = 2.00; 99.9% CI,1.06-3.78).围手术期肺部并发症与LOS增加相关 (THA = 3.03 天; 99.9% CI,2.76-3.31; TKA = + 2.72 天; 99.9% CI,2.58-2.86),住院费用增加 (THA = + 9163 美元; 99.9% CI,8054-10,272; TKA = + 7257 美元; 99.9% CI,6650-7865),死亡率增加(THA: aOR = 121; 99.9% CI,78-187; TKA: aOR = 150; 95% CI,97-233)。 结论: 尽管总体发病率有所下降,但围手术期肺部并发症是围手术期发病率和死亡率的重要潜在来源。目前的研究强调了肺部并发症的潜在危险因素。识别这些因素可能有助于更好地对患者进行分层并降低潜在并发症的风险。呼吸衰竭尤其如此,因为它与该组中资源利用率和死亡率的高增加相关。

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肺炎方向

肺炎是指终末气道、肺泡和肺间质的炎症。可由细菌、病毒、真菌、寄生虫等致病微生物,以及放射线、吸入性异物等理化因素引起。临床主要症状为发热、咳嗽、咳痰、痰中带血,可伴胸痛或呼吸困难等。

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