背景:该研究针对越来越多的接受关节置换术的血液透析(HD)患者,有较高的并发症和死亡率的风险。以前的研究往往忽视了出院后的死亡。这项研究旨在检查因选择性和骨折相关原因接受关节置换术的大型全国队列患者的早期结局。
方法:在2016年至2022年之间,使用Türkiye卫生部的e-Nab²z数据库进行了一项研究,重点关注18岁及以上接受择期或骨折相关关节成形术的患者。这项研究包括1,287例依赖透析的患者,他们接受了全髋关节置换术,全膝关节置换术,或半髋关节置换术(HA),其中7.7%是首次接受透析。倾向评分匹配用于创建一个大小相等的非透析依赖患者组,确保人口在年龄方面的平衡,性别,合并症指数,和手术类型。主要目的是比较关节置换术后10、30和90天的死亡率。
结果:首次接受HA的透析患者30天和90天死亡率明显高于慢性透析组(P=0.040和P<.001,分别)。此外,在所有手术类型中,HD患者的90日死亡率始终较高.全膝关节置换术,HD患者的死亡率为8.7%,与非HD患者的0%形成鲜明对比(P<.001)。同样,全髋关节置换术,HD患者的死亡率为12%,而非HD患者的发生率明显较低,为2.7%(P=.008)。在HA的情况下,HD患者的90天死亡率显着升高,为31.9%,在非HD患者中,这一比例为17.1%(P<.001)。
结论:关节置换术在HD患者中具有较高的死亡率和并发症发生率。手术决定必须基于患者的整体健康状况,需要专家之间的合作。应密切监测这些患者。
BACKGROUND: The
study addresses the growing number of hemodialysis (HD) patients undergoing joint arthroplasty, who are at higher risk of complications and mortality. Previous research has often overlooked deaths after discharge. This
study aimed to examine early outcomes in a large nationwide cohort of patients who underwent arthroplasty for elective and fracture-related reasons.
METHODS: Between 2016 and 2022, a
study was conducted using the e-Nabız database of the Türkiye Ministry of Health, focusing on patients aged 18 years and above who underwent elective or fracture-related arthroplasty. This
study included 1,287 patients reliant on dialysis who underwent total hip arthroplasty, total knee arthroplasty, or hemiarthroplasty (HA), with 7.7% of them receiving dialysis for the first time. Propensity score matching was used to create an equally sized group of non-dialysis-dependent patients, ensuring demographic balance in terms of age, sex, a comorbidity index, and surgery type. The primary objective was to compare mortality rates 10, 30, and 90 days after arthroplasty.
RESULTS: The first-time dialysis patients who underwent HA had significantly higher 30- and 90-day mortality rates compared to the chronic dialysis group (P = .040 and P < .001, respectively). Also, the HD patients consistently exhibited higher 90-day mortality rates across all surgery types. With total knee arthroplasty, HD patients had a mortality rate of 8.7%, in stark contrast to 0% among non-HD patients (P < .001). Similarly, with total hip arthroplasty, HD patients had a 12% mortality rate, while non-HD patients had a markedly lower rate of 2.7% (P = .008). In the case of HA, HD patients had a significantly elevated 90-day mortality rate of 31.9%, in contrast to 17.1% among non-HD patients (P < .001).
CONCLUSIONS: Joint arthroplasty has higher rates of mortality and complications among HD patients. Surgical decisions must be based on patients\' overall health, necessitating collaboration among specialists. These patients should be closely monitored.