炎症性肠病是全肩关节置换术后并发症的独立预测因子

Q4 Medicine

Seminars in Arthroplasty Pub Date : 2025-01-21 DOI:10.1053/j.sart.2024.12.007

Jason Silvestre MD , Alexander S. Guareschi MD , Brandon L. Rogalski MD , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC

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引用次数: 0

摘要

炎症性肠病（IBD）患者对全肩关节置换术（TSA）的需求预计会增加。本研究的目的是确定IBD（克罗恩病[CD]和溃疡性结肠炎[UC]）患者与非IBD患者在原发性TSA后的围手术期结局。方法查询国家再入院数据库，确定2010年至2020年期间683例CD患者和566例UC患者接受了原发性TSA。病例对照匹配根据年龄、性别和术前医疗诊断按1:3的比例生成对照。主要结局包括术后内科和外科并发症、180天内的临床结局、总住院时间、出院处置和TSA后的总护理费用。计算95%置信区间（ci）的比值比（ORs）。多因素分析确定了TSA术后并发症的独立危险因素。结果与对照组相比，接受TSA的CD患者出现并发症的几率更高，包括败血症（OR 35， CI, 8.2-148）、脱位（OR 27, 3.4-211）、假体松动（OR 21, 2.5-168）、输血需求（OR 8.9， CI, 2.9-28）和急性呼吸窘迫综合征（OR 8.5， CI, 3.3-22）。与匹配的对照组相比，接受TSA的UC患者发生败血症（OR 15, CI 1.7-129）、急性呼吸窘迫综合征（OR 7.9, CI 2.8-22）和急性肾功能衰竭（OR 3.2, CI 1.7-6.0）的几率更高。与对照组相比，两组患者的再入院率、TSA修订率或死亡率均无差异。UC患者的总护理费用（20,808美元对17,488美元）更高。然而，对于CD和UC患者，住院时间和出院处置与匹配的对照组相似。在多变量分析中，CD和UC被确定为医疗和种植体相关并发症的独立危险因素，包括脱位和假体松动(P <；措施)。结论ibd是原发性TSA后较高的内科和外科并发症发生率的独立危险因素。这些信息可以帮助骨科医生适当地向IBD患者咨询TSA后的风险。

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Inflammatory bowel disease is an independent predictor for complications following total shoulder arthroplasty

Background

The demand for total shoulder arthroplasty (TSA) in patients with inflammatory bowel disease (IBD) is expected to increase. The purpose of this study is to determine the perioperative outcomes in patients with IBD (Crohn’s disease [CD] and ulcerative colitis [UC]) compared to those without IBD following primary TSA.

Methods

The National Readmission Database was queried to identify 683 patients with CD and 566 patients with UC undergoing primary TSA between 2010 and 2020. Case–control matching generated controls in a 1:3 proportion based on age, sex, and preoperative medical diagnoses. Primary outcomes included postoperative medical and surgical complications, clinical outcomes within 180 days, total hospital length of stay, discharge disposition, and total costs of care after TSA. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Multivariate analyses identified independent risk factors for postoperative complications after TSA.

Results

Compared to matched controls, patients with CD undergoing TSA had higher odds of complications including sepsis (OR 35, CI, 8.2-148), dislocation (OR 27, 3.4-211), prosthetic loosening (OR 21, 2.5-168), transfusion requirement (OR 8.9, CI, 2.9-28), and acute respiratory distress syndrome (OR 8.5, CI, 3.3-22). Compared to matched controls, patients with UC undergoing TSA had higher odds of sepsis (OR 15, CI, 1.7-129), acute respiratory distress syndrome (OR 7.9, CI, 2.8-22), and acute renal failure (OR 3.2, CI, 1.7-6.0). No differences in rates of readmission, revision TSA, or mortality were observed between the 2 groups relative to their controls. Total cost of care ($20,808 vs. $17,488) was higher in patients with UC. However, length of stay and discharge disposition was similar to matched controls for both CD and UC patients. On multivariate analysis, CD and UC were identified as independent risk factors for medical and implant-related complications, including dislocation and prosthetic loosening (P < .001).

Conclusion

IBD is an independent risk factor for higher rates of medical and surgical complications following primary TSA. This information can help orthopedic surgeons appropriately counsel patients with IBD on the risks following TSA.

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来源期刊

Seminars in Arthroplasty Medicine-Surgery

CiteScore

1.00

自引率

0.00%

发文量

104

期刊介绍： Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice.