Age and Ageing:全髋关节置换术/全膝关节置换术后短期死亡率随机体虚弱程度增加而增加

2022-06-28 影像小生 MedSci原创

全髋关节置换术/全膝关节置换术后短期死亡率随身体虚弱程度增加而增加。

在骨关节炎(OA)患者中,即使保守治疗后仍有症状的患者可能需要进行关节置换手术,包括全髋关节置换术(THA)和全膝关节置换术(TKA)。全髋关节置换术和全膝关节置换术均与短期死亡率高峰相关,术后90天内死亡率下降。许多因素与全髋关节置换术和全膝关节置换术后死亡率增加有关,包括年龄和虚弱。先前的研究表明,全髋关节置换术和全膝关节置换术后90天内的死亡率随机体虚弱程度的增加而增加,与年龄无关。

然而,在一般人群中,虚弱也与死亡率增加有关。因此,目前尚不清楚体质对髋关节和膝关节置换术后短期死亡率的影响是否与未行手术的个体的体质对死亡率的影响不同。此前没有研究关注骨性关节炎患者在全髋关节置换术和全膝关节置换术后的虚弱和短期死亡率之间的关系,与年龄、性别和剥夺匹配的骨性关节炎但未进行关节手术的对照组相比,这与死亡风险增加有关。这些数据很重要,可能有助于患者和医疗保健专业人员就是否继续进行全髋关节置换术或全膝关节置换术进行决策。

Age and Ageing最近刊发了曼彻斯特大学Terence W. O’Neill等的研究文章,该研究确定了骨性关节炎患者在全髋关节和膝关节置换术(THA/TKA)后的虚弱和短期死亡率之间的关系,以及与对照组相比,全髋关节和膝关节置换术对短期死亡率的影响。

使用衰弱指数(分类:健康,轻度,中度,严重衰弱)评估衰弱。采用Cox回归法评估全髋关节置换术/全膝关节置换术后虚弱和短期死亡率之间的关系。全髋关节置换术/全膝关节置换术后的死亡率也与没有全髋关节置换术/全膝关节置换术前的骨性关节炎对照组进行了比较,其出生年份、性别和多重剥夺指数的五分位数相匹配。

共有103563例全髋关节置换术患者,125367例全髋关节置换术患者和匹配对照患者参与了这一研究。

该研究发现:

在接受手术的患者中,死亡率随着身体虚弱程度的增加而增加在严重体弱和健康的情况下,30天调整后的风险比(HR) (95% CI):全髋关节置换术后为2.85(1.84,4.39),全髋关节置换术后为2.14(1.29,3.53)。

全髋关节置换术或全膝关节置换术患者按虚弱程度分类的30天、60天和90天死亡率风险比

全髋关节置换术/全膝关节置换术后30天死亡率的预测概率因年龄、性别和体质不同而不同全髋关节置换术后,60-64岁的健康女性的0.05%到90岁以上的严重体质男性的6.55%。全髋关节置换术和全膝关节置换术后,与正常对照组相比,适应症患者的全因30天死亡率分别增加(调整后HR(95% CI)为1.60(1.15,2.21)和2.98(1.81,4.89)),但在同一适应症类别中,轻度、中度或重度衰弱患者与对照组相比没有增加。

按年龄和虚弱程度预测男性和女性髋关节和膝关节置换术后30天死亡率的概率

总之,该研究表明全髋关节置换术/全膝关节置换术后短期死亡率随机体虚弱程度增加而增加。病例和对照组死亡率的比较可能会受到“健康手术”选择效应的影响。

 

原文出处

Michael J Cook, Mark Lunt, Timothy Board, Terence W O’Neill, The impact of frailty on short-term mortality following primary total hip and knee arthroplasty due to osteoarthritis, Age and Ageing, Volume 51, Issue 6, June 2022, afac118, https://doi.org/10.1093/ageing/afac118.

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    2022-06-27 yxch48
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