背景:全肩关节置换术(TSA)是一项常见的手术,可以考虑用于肱骨关节炎患者。接受此手术的患者可能会受到合并症的困扰,如系统性红斑狼疮(SLE),这可能会影响各种术后并发症的几率。
方法:从2010年1月至2022年10月PearlDiverM165数据库查询患有和不患有SLE且接受TSA(解剖或逆转)的成年患者。有和没有SLE的患者根据年龄进行匹配(1:4),性别,和Elixhauser合并症指数。评估90天不良事件和5年植入物生存率,并与多变量分析进行比较。对有或没有免疫调节疗法处方的SLE患者进行了子分析(IMT-皮质类固醇,羟氯喹,和/或生物制剂)在手术前90天内,并与非SLE患者进行多变量分析。最后,将有或没有90天IMT病史的SLE患者直接与多变量逻辑回归进行比较。将Bonferroni校正应用于单变量分析和多变量回归。
结果:在211,832名TSA患者中,SLE为2,228(1.1%)。匹配后,选择8,261例无SLE患者和2,085例SLE患者。SLE患者发生90天汇总事件的几率增加,包括严重事件(OR=3.50),未成年人(OR=3.13),所有(OR=2.35),和骨科相关(OR=1.41)不良事件(全部p<0.0030)。植入物的5年生存率没有差异。在患有SLE的人中,1,267(60.8%)接受了IMT药物治疗。任何,严重,未成年人,与无SLE患者相比,有IMT患者和无IMT患者的90天骨科不良事件均显著升高(P<0.0030,但无IMT患者的骨科相关不良事件均不显著).相对于那些没有服用IMT药物的人,那些使用IMT药物的人的几率明显更高,严重,未成年人,和骨科相关不良事件。
结论:在TSA之后,研究发现,SLE患者发生90日不良事件的机率增加,但未发生5年修正.此外,那些服用IMT药物的人有更高的风险,严重,未成年人,与未使用这些药物的患者相比,骨科相关的不良事件。当考虑使用TSA治疗SLE患者时,这些发现可能有助于患者咨询和手术计划。
BACKGROUND: Total shoulder arthroplasty (TSA) is a common procedure that may be considered for patients with glenohumeral osteoarthritis. Patients undergoing this procedure may be afflicted by comorbid conditions, such as systemic lupus erythematosus (SLE), which may impact odds of various postoperative complications.
METHODS: Adult patients with and without SLE who underwent TSA (anatomic or reverse) were queried from the Jan 2010 to Oct 2022 PearlDiver M165 database. Patients with and without SLE were matched (1:4) based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events and five-year implant survival were assessed and compared with multivariable analysis. Sub-analyses were done for SLE patients with and without a prescription of immunomodulatory therapy (IMT - corticosteroids, hydroxychloroquine, and/or biologics) within 90 days prior to surgery and compared to non-SLE patients with multivariable analyses. Lastly, SLE patients with and without a 90-day history of IMT were directly compared with multivariate logistic regression. A Bonferroni correction was applied to univariable analyses and multivariable regressions.
RESULTS: Of 211,832 TSA patients identified, SLE was noted for 2,228 (1.1%). After matching, 8,261 patients without SLE and 2,085 patients with SLE were selected. SLE patients were at an increased odds of 90-day aggregated events including severe (OR=3.50), minor (OR=3.13), all (OR=2.35), and orthopedic-related (OR=1.41) adverse events (p<0.0030 for all). There was no difference in 5-year implant survival. Of those with SLE, IMT medications were being received by 1,267 (60.8%). Any, severe, minor, and orthopedic 90-day adverse events were significantly elevated for both those with and without IMT relative to those without SLE (p<0.0030 for all except for orthopedic-related adverse events for those not on IMT which were not significant). Relative to those not on IMT medications, those on IMT medications were at significantly higher odds of any, severe, minor, and orthopedic-related adverse events.
CONCLUSIONS: Following TSA, patients with SLE were found to be at an increased odds of 90-day adverse events but not of 5-year revisions. Furthermore, those on IMT medications were at higher risk of any, severe, minor, and orthopedic-related adverse events compared to those who were not on these medications. These findings may help with patient counselling and surgical planning when those with SLE are considered for TSA.