背景:在过去的几十年中,全髋关节置换术(THA)的数量逐渐增加,假体周围骨折(PPF)的患者比例显著增加.在这种情况下,清楚了解THA后患者发生PPF的因素以及这些不良并发症对整体医疗负担的影响的必要性不可低估.
方法:基于全国住院患者样本(NIS)数据库,我们确定了2016年至2019年在美国接受THA的患者(使用ICD-10CMP代码).将患者分为2组;A组-维持PPF的患者,B组-未维持PPF的患者。关于病人的人口统计资料,分析了医疗合并症;和住院时间(包括住院时间和发生的费用);并在两组之间进行了比较。
结果:总体而言,367,890例患者接受了THA,其中4,425人(1.2%)患有PPF(A组)。其余患者归入B组(363,465名患者)。在多变量分析(MVA)的基础上,女性的比例明显更高,老年患者,A组的急诊入院(p<0.001),住院时间,A组的支出和死亡率也明显更高(p=0.001),基于MVA,唐氏综合征(奇数比3.15,p=0.01),H/O结肠造口术(奇数比2.09,p=0.008),肝硬化(奇数比2.01,p<0.001),帕金森病(奇数比1.49,p=0.004),病态肥胖(奇数比1.44,p<0.001),超级肥胖(奇数比1.49,p=0.03),和H/OCABG(冠状动脉旁路移植术;奇数比值1.21,p=0.03)显示与PPF显著相关(A组)。
结论:PPF患者需要更高的紧急入院率,住院时间更长,入院相关支出增加。女性性别,高龄,病态或超级肥胖,和存在医疗合并症(如唐氏综合症,肝硬化,帕金森病,以前的结肠造口术,和先前的CABG)显着增加THA后PPF的风险。这些医疗条件必须保持在临床医生的头脑和密切随访需要在这种情况下,以减轻这些并发症。
BACKGROUND: With a progressive rise in the number of total hip arthroplasties (THA) over the past decades, the proportion of patients sustaining peri-prosthetic fractures (PPF) has been substantially increasing. In this context, the need for clearly understanding the factors predisposing patients to PPF following THA and the impact of these adverse complications on the overall healthcare burden cannot be understated.
METHODS: Based upon the Nationwide Inpatient Sample (NIS) database, the patients who underwent THA in the United States between 2016 and2019 (with ICD-10 CMP code) were identified. The patients were divided into 2 groups; group A - patients who sustained PPF and group B - those who did not. The information about the patients\' demographic profile, medical comorbidities; and hospital admission (including length of stay and expenditure incurred) were analysed; and compared between the 2 groups.
RESULTS: Overall, 367,890 patients underwent THA, among whom 4,425 (1.2%) sustained PPF (group A). The remaining patients were classified under group B (363,465 patients). On the basis of multi-variate analysis (MVA), there was a significantly greater proportion of females, elderly patients, and emergent admissions (p < 0.001) in group A. The length of hospital stay, expenditure incurred and mortality were also significantly higher (p = 0.001) in group A. Based on MVA, Down\'s syndrome (odd\'s ratio 3.15, p = 0.01), H/O colostomy (odd\'s ratio 2.09, p = 0.008), liver cirrhosis (odd\'s ratio 2.01, p < 0.001), Parkinson\'s disease (odd\'s ratio 1.49, p = 0.004), morbid obesity (odd\'s ratio 1.44, p < 0.001), super obesity (odd\'s ratio 1.49, p = 0.03), and H/O CABG (coronary artery bypass graft; odd\'s ratio 1.21, p = 0.03) demonstrated significant association with PPF (group A).
CONCLUSIONS: Patients with PPF require higher rates of emergent admission, longer hospital stay and greater admission-related expenditure. Female sex, advanced age, morbid or super obesity, and presence of medical comorbidities (such as Down\'s syndrome, cirrhosis, Parkinson\'s disease, previous colostomy, and previous CABG) significantly enhance the risk of PPF after THA. These medical conditions must be kept in clinicians\' minds and close follow-up needs to be implemented in such situations so as to mitigate these complications.