PDF(Pubmed)
Abstract：
It remains unclear whether a history of recent COVID-19 infection affects the outcomes and risks of complications of total joint arthroplasty (TJA). The purpose of this study was to compare the outcomes of TJA in patients who have and have not had a recent COVID-19 infection.
A large national database was queried for patients undergoing total hip and total knee arthroplasty. Patients who had a diagnosis of COVID-19 within 90-days preoperatively were matched to patients who did not have a history of COVID-19 based on age, sex, Charlson Comorbidity Index, and procedure. A total of 31,453 patients undergoing TJA were identified, of which 616 (2.0%) had a preoperative diagnosis of COVID-19. Of these, 281 COVID-19 positive patients were matched with 281 patients who did not have COVID-19. The 90-day complications were compared between patients who did and did not have a diagnosis of COVID-19 at 1, 2, and 3 months preoperatively. Multivariate analyses were used to further control for potential confounders.
Multivariate analysis of the matched cohorts showed that COVID-19 infection within 1 month prior to TJA was associated with an increased rate of postoperative deep vein thrombosis (odds ratio [OR]: 6.50, 95% confidence interval: 1.48-28.45, P = .010) and venous thromboembolic events (odds ratio: 8.32, confidence interval: 2.12-34.84, P = .002). COVID-19 infection within 2 and 3 months prior to TJA did not significantly affect outcomes.
COVID-19 infection within 1 month prior to TJA significantly increases the risk of postoperative thromboembolic events; however, complication rates returned to baseline after that time point. Surgeons should consider delaying elective total hip arthroplasty and total knee arthroplasty until 1 month after a COVID-19 infection.
A large national database was queried for patients undergoing total hip and total knee arthroplasty. Patients who had a diagnosis of COVID-19 within 90-days preoperatively were matched to patients who did not have a history of COVID-19 based on age, sex, Charlson Comorbidity Index, and procedure. A total of 31,453 patients undergoing TJA were identified, of which 616 (2.0%) had a preoperative diagnosis of COVID-19. Of these, 281 COVID-19 positive patients were matched with 281 patients who did not have COVID-19. The 90-day complications were compared between patients who did and did not have a diagnosis of COVID-19 at 1, 2, and 3 months preoperatively. Multivariate analyses were used to further control for potential confounders.
Multivariate analysis of the matched cohorts showed that COVID-19 infection within 1 month prior to TJA was associated with an increased rate of postoperative deep vein thrombosis (odds ratio [OR]: 6.50, 95% confidence interval: 1.48-28.45, P = .010) and venous thromboembolic events (odds ratio: 8.32, confidence interval: 2.12-34.84, P = .002). COVID-19 infection within 2 and 3 months prior to TJA did not significantly affect outcomes.
COVID-19 infection within 1 month prior to TJA significantly increases the risk of postoperative thromboembolic events; however, complication rates returned to baseline after that time point. Surgeons should consider delaying elective total hip arthroplasty and total knee arthroplasty until 1 month after a COVID-19 infection.
摘要：
背景：目前尚不清楚近期COVID-19感染史是否会影响全关节置换术（TJA）的预后和并发症风险。这项研究的目的是比较TJA在最近感染和没有感染COVID-19的患者中的预后。
方法：在一个大型国家数据库中查询了接受全髋关节（THA）和全膝关节置换术（TKA）的患者。术前90天内诊断为COVID-19的患者与没有COVID-19病史的患者的年龄相匹配，性别,Charlson合并症指数（CCI），和程序。共有31,453名接受TJA的患者被确定，其中616例（2.0%）术前诊断为COVID-19。其中,281例COVID-19阳性患者与281例没有COVID-19的患者相匹配。比较了术前1、2和3个月诊断为COVID-19和未诊断为COVID-19的患者的90天并发症。多变量分析用于进一步控制潜在的混杂因素。
结果：匹配队列的多变量分析显示，TJA前1个月内COVID-19感染与术后深静脉血栓形成率增加有关（DVT，优势比[OR]6.50，95%置信区间[CI]，1.48-28.45，p=0.010）和静脉血栓栓塞事件（VTE，或8.32，CI2.12-34.84)，p=0.002)。在TJA之前的2个月和3个月内，COVID-19感染对预后没有显着影响。
结论：TJA前1个月内COVID-19感染显著增加术后血栓栓塞事件的风险，然而,在该时间点之后,并发症发生率恢复至基线.外科医生应考虑将选择性THA和TKA推迟到COVID-19感染后一个月。
方法：在一个大型国家数据库中查询了接受全髋关节（THA）和全膝关节置换术（TKA）的患者。
结果：匹配队列的多变量分析显示，TJA前1个月内COVID-19感染与术后深静脉血栓形成率增加有关（DVT，
结论：TJA前1个月内COVID-19感染显著增加术后血栓栓塞事件的风险，
