美国医院当代全膝关节置换术 (TKAs) 中静脉血栓栓塞事件 (VTE) 的发生率和临床负担

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2024-10-08 DOI:10.1016/j.jor.2024.10.006

Halil Ibrahim Bulut , Maria Jose Maestre , Daniel Tomey

{"title":"美国医院当代全膝关节置换术 (TKAs) 中静脉血栓栓塞事件 (VTE) 的发生率和临床负担","authors":"Halil Ibrahim Bulut , Maria Jose Maestre , Daniel Tomey","doi":"10.1016/j.jor.2024.10.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Total knee arthroplasty (TKA) is a highly demanded procedure in orthopedic surgery, with over 1.3 million joint arthroplasties performed annually in the U.S. The increasing need for TKAs is driven by an aging population, rising obesity rates, and advances in surgical techniques. Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), significantly impacts TKA patients' mortality and morbidity. Despite advances in prophylaxis and Enhanced Recovery After Surgery (ERAS) protocols reducing VTE incidence, survival rates have not markedly improved. This study aims to identify preoperative predictors of PE and DVT in TKA patients and examine their impact on hospital stays and mortality.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, focusing on 367,365 TKA patients from 2016 to 2021. Preoperative variables, including demographic factors, comorbidities, and functional status, were analyzed. Primary endpoints were PE and DVT predictors; secondary endpoints included 30-day mortality and prolonged hospital stay. Univariate and logistic regression analyses were performed using SPSS version 26.</div></div><div><h3>Results</h3><div>Univariate analysis revealed significant associations of male gender, older age, Hispanic ethnicity, smoking, dyspnea, CHF, and COPD with DVT and PE. Multivariate analysis confirmed female sex, younger age, Hispanic ethnicity, and COPD as independent DVT predictors, and independent functional status, smoking, COPD, CHF, and metastatic malignancy as PE predictors. VTE prevalence was 1.09 % (0.67 % DVT, 0.42 % PE), with PE associated with higher mortality (0.78 %) and prolonged hospital stays.</div></div><div><h3>Conclusion</h3><div>Demographic and clinical variables significantly influence VTE risk post-TKA. Tailored interventions and comprehensive preoperative assessments are crucial for optimizing patient outcomes and reducing thrombotic risks.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence and clinical burden of venous thromboembolic events (VTEs) in contemporary total knee arthroplasties (TKAs) in US hospitals\",\"authors\":\"Halil Ibrahim Bulut , Maria Jose Maestre , Daniel Tomey\",\"doi\":\"10.1016/j.jor.2024.10.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Total knee arthroplasty (TKA) is a highly demanded procedure in orthopedic surgery, with over 1.3 million joint arthroplasties performed annually in the U.S. The increasing need for TKAs is driven by an aging population, rising obesity rates, and advances in surgical techniques. Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), significantly impacts TKA patients' mortality and morbidity. Despite advances in prophylaxis and Enhanced Recovery After Surgery (ERAS) protocols reducing VTE incidence, survival rates have not markedly improved. This study aims to identify preoperative predictors of PE and DVT in TKA patients and examine their impact on hospital stays and mortality.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, focusing on 367,365 TKA patients from 2016 to 2021. Preoperative variables, including demographic factors, comorbidities, and functional status, were analyzed. Primary endpoints were PE and DVT predictors; secondary endpoints included 30-day mortality and prolonged hospital stay. Univariate and logistic regression analyses were performed using SPSS version 26.</div></div><div><h3>Results</h3><div>Univariate analysis revealed significant associations of male gender, older age, Hispanic ethnicity, smoking, dyspnea, CHF, and COPD with DVT and PE. Multivariate analysis confirmed female sex, younger age, Hispanic ethnicity, and COPD as independent DVT predictors, and independent functional status, smoking, COPD, CHF, and metastatic malignancy as PE predictors. VTE prevalence was 1.09 % (0.67 % DVT, 0.42 % PE), with PE associated with higher mortality (0.78 %) and prolonged hospital stays.</div></div><div><h3>Conclusion</h3><div>Demographic and clinical variables significantly influence VTE risk post-TKA. Tailored interventions and comprehensive preoperative assessments are crucial for optimizing patient outcomes and reducing thrombotic risks.</div></div>\",\"PeriodicalId\":16633,\"journal\":{\"name\":\"Journal of orthopaedics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-10-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of orthopaedics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0972978X24003349\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0972978X24003349","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

导言全膝关节置换术（TKA）是骨科手术中需求量很大的一种手术，美国每年进行的关节置换术超过 130 万例。静脉血栓栓塞症（VTE），包括肺栓塞（PE）和深静脉血栓形成（DVT），严重影响了 TKA 患者的死亡率和发病率。尽管预防措施和术后加强恢复（ERAS）方案降低了 VTE 的发生率，但存活率并没有明显提高。本研究旨在确定TKA患者术前发生PE和DVT的预测因素，并研究其对住院时间和死亡率的影响。方法利用美国外科学院国家外科质量改进计划（ACS NSQIP）数据库中的数据开展了一项回顾性观察研究，研究对象为2016年至2021年的367365名TKA患者。对包括人口统计学因素、合并症和功能状态在内的术前变量进行了分析。主要终点是PE和DVT预测因子；次要终点包括30天死亡率和住院时间延长。使用 SPSS 26 版进行了单变量和逻辑回归分析。结果单变量分析显示，男性、高龄、西班牙裔、吸烟、呼吸困难、慢性心力衰竭和慢性阻塞性肺病与深静脉血栓形成和 PE 有显著相关性。多变量分析证实，女性性别、较年轻的年龄、西班牙裔和慢性阻塞性肺病是预测深静脉血栓形成的独立因素，而功能状态、吸烟、慢性阻塞性肺病、慢性心力衰竭和转移性恶性肿瘤是预测 PE 的独立因素。VTE发生率为1.09%（DVT为0.67%，PE为0.42%），其中PE与较高的死亡率（0.78%）和住院时间延长有关。有针对性的干预措施和全面的术前评估对优化患者预后和降低血栓风险至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Prevalence and clinical burden of venous thromboembolic events (VTEs) in contemporary total knee arthroplasties (TKAs) in US hospitals

Introduction

Total knee arthroplasty (TKA) is a highly demanded procedure in orthopedic surgery, with over 1.3 million joint arthroplasties performed annually in the U.S. The increasing need for TKAs is driven by an aging population, rising obesity rates, and advances in surgical techniques. Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), significantly impacts TKA patients' mortality and morbidity. Despite advances in prophylaxis and Enhanced Recovery After Surgery (ERAS) protocols reducing VTE incidence, survival rates have not markedly improved. This study aims to identify preoperative predictors of PE and DVT in TKA patients and examine their impact on hospital stays and mortality.

Methods

A retrospective observational study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, focusing on 367,365 TKA patients from 2016 to 2021. Preoperative variables, including demographic factors, comorbidities, and functional status, were analyzed. Primary endpoints were PE and DVT predictors; secondary endpoints included 30-day mortality and prolonged hospital stay. Univariate and logistic regression analyses were performed using SPSS version 26.

Results

Univariate analysis revealed significant associations of male gender, older age, Hispanic ethnicity, smoking, dyspnea, CHF, and COPD with DVT and PE. Multivariate analysis confirmed female sex, younger age, Hispanic ethnicity, and COPD as independent DVT predictors, and independent functional status, smoking, COPD, CHF, and metastatic malignancy as PE predictors. VTE prevalence was 1.09 % (0.67 % DVT, 0.42 % PE), with PE associated with higher mortality (0.78 %) and prolonged hospital stays.

Conclusion

Demographic and clinical variables significantly influence VTE risk post-TKA. Tailored interventions and comprehensive preoperative assessments are crucial for optimizing patient outcomes and reducing thrombotic risks.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.