{"title":"初次全髋关节置换术后早期假体脱位的再入院","authors":"Wesley M. Durand, W. Long, R. Schwarzkopf","doi":"10.1055/s-0040-1705101","DOIUrl":null,"url":null,"abstract":"Abstract Prosthetic dislocation in total hip arthroplasty (THA) is the most common cause for readmission in the 90 days following surgery. This investigation sought to quantify risk factors for readmission for early prosthetic dislocation within 30 days after primary THA. This study used the National Surgical Quality Improvement Program (NSQIP) database for the years 2012 to 2017. The primary outcome was reoperation or readmission for prosthetic dislocation within 30 days after primary total hip replacement. Secondary outcomes included native NSQIP medical complications. A total of 159,234 patients were included. Of these, 0.25% (n = 399) experienced reoperation or readmission for prosthetic dislocation within 30 days postoperatively. A total of 217 dislocated hips (54.4%) returned to the operating room only once, and 27 hips (6.8%) returned to the operating room twice. The mean day of first reoperation/readmission for dislocation was 13.5 (standard deviation [SD]: 9.0). In multivariable logistic regression, the following factors were significantly associated with early reoperation/readmission for prosthetic dislocation: patient age 80+ years (odds ratio [OR]: 1.51 vs. 50–59), high creatinine (OR: 1.75 vs. normal range), smoking (OR: 1.53), history of severe chronic obstructive pulmonary disease (COPD) (OR: 1.73), general anesthesia (OR: 1.41 vs. spinal), American Society of Anesthesiologists (ASA) class 3–5 (OR: 1.66 vs. 1 or 2), fracture (OR: 2.17), chronic steroid use (OR: 1.54), and operative duration ≥ 2 hours (all p < 0.05). Early prosthetic dislocation was significantly associated with the further development of surgical site infection (OR: 2.25) (both p < 0.05). This study identified risk factors for early reoperation/readmission for prosthetic dislocation after THA. These findings have implications for preoperative planning, postoperative management, and dislocation precautions.","PeriodicalId":427844,"journal":{"name":"The Journal of Hip Surgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Readmission for Early Prosthetic Dislocation after Primary Total Hip Arthroplasty\",\"authors\":\"Wesley M. Durand, W. Long, R. Schwarzkopf\",\"doi\":\"10.1055/s-0040-1705101\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Abstract Prosthetic dislocation in total hip arthroplasty (THA) is the most common cause for readmission in the 90 days following surgery. This investigation sought to quantify risk factors for readmission for early prosthetic dislocation within 30 days after primary THA. This study used the National Surgical Quality Improvement Program (NSQIP) database for the years 2012 to 2017. The primary outcome was reoperation or readmission for prosthetic dislocation within 30 days after primary total hip replacement. Secondary outcomes included native NSQIP medical complications. A total of 159,234 patients were included. Of these, 0.25% (n = 399) experienced reoperation or readmission for prosthetic dislocation within 30 days postoperatively. A total of 217 dislocated hips (54.4%) returned to the operating room only once, and 27 hips (6.8%) returned to the operating room twice. The mean day of first reoperation/readmission for dislocation was 13.5 (standard deviation [SD]: 9.0). In multivariable logistic regression, the following factors were significantly associated with early reoperation/readmission for prosthetic dislocation: patient age 80+ years (odds ratio [OR]: 1.51 vs. 50–59), high creatinine (OR: 1.75 vs. normal range), smoking (OR: 1.53), history of severe chronic obstructive pulmonary disease (COPD) (OR: 1.73), general anesthesia (OR: 1.41 vs. spinal), American Society of Anesthesiologists (ASA) class 3–5 (OR: 1.66 vs. 1 or 2), fracture (OR: 2.17), chronic steroid use (OR: 1.54), and operative duration ≥ 2 hours (all p < 0.05). Early prosthetic dislocation was significantly associated with the further development of surgical site infection (OR: 2.25) (both p < 0.05). This study identified risk factors for early reoperation/readmission for prosthetic dislocation after THA. These findings have implications for preoperative planning, postoperative management, and dislocation precautions.\",\"PeriodicalId\":427844,\"journal\":{\"name\":\"The Journal of Hip Surgery\",\"volume\":\"43 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Journal of Hip Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1055/s-0040-1705101\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of Hip Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0040-1705101","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2
摘要
摘要全髋关节置换术(THA)中假体脱位是术后90天再入院的最常见原因。本研究旨在量化原发性THA术后30天内早期假体脱位再入院的危险因素。本研究使用了2012年至2017年国家外科质量改进计划(NSQIP)数据库。主要结果为首次全髋关节置换术后30天内因假体脱位再次手术或再入院。次要结局包括原生NSQIP医学并发症。共纳入159234例患者。其中,0.25% (n = 399)在术后30天内因假体脱位再次手术或再次入院。脱位髋217例(54.4%)仅一次复诊,27例(6.8%)两次复诊。脱位首次再手术/再入院的平均时间为13.5天(标准差[SD]: 9.0)。在多变量logistic回归中,以下因素与假体脱位的早期再手术/再住院显著相关:患者年龄80岁以上(比值比[OR]: 1.51 vs. 50-59)、高肌酐(比值比[OR]: 1.75 vs.正常范围)、吸烟(比值比:1.53)、严重慢性阻塞性肺疾病(COPD)史(比值比:1.73)、全身麻醉(比值比:1.41 vs.脊柱)、美国麻醉医师学会(ASA) 3-5级(比值比:1.66 vs. 1或2)、骨折(比值比:1或2)。2.17),慢性类固醇使用(OR: 1.54),手术时间≥2小时(均p < 0.05)。早期假体脱位与手术部位感染的进一步发展显著相关(OR: 2.25)(均p < 0.05)。本研究确定了THA术后假体脱位早期再手术/再入院的危险因素。这些发现对术前计划、术后处理和脱位预防具有指导意义。
Readmission for Early Prosthetic Dislocation after Primary Total Hip Arthroplasty
Abstract Prosthetic dislocation in total hip arthroplasty (THA) is the most common cause for readmission in the 90 days following surgery. This investigation sought to quantify risk factors for readmission for early prosthetic dislocation within 30 days after primary THA. This study used the National Surgical Quality Improvement Program (NSQIP) database for the years 2012 to 2017. The primary outcome was reoperation or readmission for prosthetic dislocation within 30 days after primary total hip replacement. Secondary outcomes included native NSQIP medical complications. A total of 159,234 patients were included. Of these, 0.25% (n = 399) experienced reoperation or readmission for prosthetic dislocation within 30 days postoperatively. A total of 217 dislocated hips (54.4%) returned to the operating room only once, and 27 hips (6.8%) returned to the operating room twice. The mean day of first reoperation/readmission for dislocation was 13.5 (standard deviation [SD]: 9.0). In multivariable logistic regression, the following factors were significantly associated with early reoperation/readmission for prosthetic dislocation: patient age 80+ years (odds ratio [OR]: 1.51 vs. 50–59), high creatinine (OR: 1.75 vs. normal range), smoking (OR: 1.53), history of severe chronic obstructive pulmonary disease (COPD) (OR: 1.73), general anesthesia (OR: 1.41 vs. spinal), American Society of Anesthesiologists (ASA) class 3–5 (OR: 1.66 vs. 1 or 2), fracture (OR: 2.17), chronic steroid use (OR: 1.54), and operative duration ≥ 2 hours (all p < 0.05). Early prosthetic dislocation was significantly associated with the further development of surgical site infection (OR: 2.25) (both p < 0.05). This study identified risk factors for early reoperation/readmission for prosthetic dislocation after THA. These findings have implications for preoperative planning, postoperative management, and dislocation precautions.