[1]包良笑,刘兆锋,谢豪,等.美国住院患者膝关节翻修术后肺部并发症发病率及危险因素分析[J].中华老年骨科与康复电子杂志,2025,(01):4-13.[doi:DOI：10.3877/cma.j.issn.2096-0263.2025.01.002]
　Bao Liangxiao,Liu Zhaofeng,Xie Hao,et al.Incidence and risk factors of pulmonary complications after revision knee arthroplasty based on USA National Inpatient Sample[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2025,(01):4-13.[doi:DOI：10.3877/cma.j.issn.2096-0263.2025.01.002]
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美国住院患者膝关节翻修术后肺部并发症发病率及危险因素分析()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2025年01期
页码:
4-13
栏目:
关节置换
出版日期:
2025-03-05

文章信息/Info

Title:
Incidence and risk factors of pulmonary complications after revision knee arthroplasty based on USA National Inpatient Sample
作者:
包良笑; 刘兆锋; 谢豪; 杨钦烽; 史占军
510515 广州，南方医科大学南方医院关节与骨病外科
Author(s):
Bao Liangxiao;  Liu Zhaofeng;  Xie Hao;  Yang Qinfeng; Shi Zhanjun.
Department of Orthopaedic Surgery, Division of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
关键词:
膝关节;  膝关节翻修术;  术后肺部并发症;  数据库
Keywords:
Knee;  Revision knee arthroplasty;  Postoperative respiratory complications;  Database
DOI:
DOI：10.3877/cma.j.issn.2096-0263.2025.01.002
文献标志码:
A
摘要:
目的 评估美国住院患者膝关节翻修术（RKA）后肺部并发症（PPC）的发病率及相关危险因素，以期为临床风险预测和围术期管理提供参考。方法 本研究回顾性分析2015至2019年美国的全国住院患者样本（NIS）数据库中，RKA患者的资料。采用 Wilcoxon 秩和检验（计量资料）和卡方检验（计数资料）评估患者的人口学指标、合并症、住院时间、住院总费用以及住院期间的死亡率；并通过logistic回归分析寻找导致RKA后PPC发生的危险因素。结果 共纳入NIS数据库74 364例RKA患者样本。RKA后PPC的总发病率为2.69%，发病率在2015-2016降低，然后从2016至2019缓慢上升，总体来说趋于平缓。RKA后出现PPC的患者有更多合并症数量、更长的住院时长、较高的住院费用以及住院期间死亡率。除此以外，他们更多使用医保进行支付（P＜0.001）。术后PPC的危险因素包括大医院（OR=1.22，P＜0.001）、非急诊/择期住院（OR=0.23，P＜0.001）、教学医院（OR=0.23，P＜0.001）、高龄（OR=1.20，P＜0.001）、酒精滥用（酗酒）（OR=1.64，P＜0.001）、营养性贫血（OR=1.26，P＜0.001）、充血性心力衰竭（OR=2.51，P＜0.001）、慢性肺部疾病（OR=1.78，P＜0.001）、凝血功能障碍（OR=2.25，P＜0.001）、水电解质紊乱（OR=4.34，P＜0.001）、转移癌（OR=2.39，P＜0.001）、神经系统疾病（OR=4.76，P＜0.001）、肥胖（OR=1.50，P＜0.001）、瘫痪（OR=2.10，P＜0.001）、外周血管疾病（OR=1.37，P＜0.001）、肺循环功能障碍（OR=2.61，P＜0.001）、肾衰竭（OR=1.21，P＜0.001）、体重减轻（营养不良）（OR=2.99，P＜0.001）、深静脉血栓（OR=6.09，P＜0.001）、术后谵妄（OR=4.84，P＜0.001）、心力衰竭（OR=1.19，P＜0.001）、败血症（OR=12.91，P＜0.001）和伤口破裂（OR=1.13，P＜0.001）。结论 RKA后PPC的总体发病率较低，但仍需关注高危患者群体。多种合并症及围术期因素与PPC的发生密切相关，特别是心肺功能受损、凝血功能障碍及营养不良等因素显著增加PPC风险。术前充分评估并优化相关危险因素，有助于降低术后PPC发生率，改善患者预后。
Abstract:
Objective The aim of this study is to determine the incidence and risk factors of pulmonary complications after revision knee arthroplasty. Methods This study conducted a retrospective analysis of patients undergoing revision knee arthroplasty using the National Inpatient Sample Database (NIS) in the United States from 2015 to 2019. This study used Wilcoxon test (continuous data) and Chi square test (categorical data) to analyze patients’ demographic indicators, comorbidities, length of stay, total hospitalization expenses, and mortality during hospitalization; And through logistic regression analysis, identify the risk factors leading to pulmonary complications after revision knee arthroplasty. Results 74 364 patient samples of revision knee arthroplasty were obtained from the NIS database. The total incidence of pulmonary complications after revision knee arthroplasty was 2.69%, and the incidence rate decreased from 2015 to 2016, then slowly increased from 2016 to 2019, and generally leveled off. Patients with pulmonary complications after revision knee arthroplasty have a higher number of comorbidities, longer hospital stay, higher hospitalization cost, and mortality during hospitalization. In addition, they use medical insurance more for payment (P<0.001). Risk factors for developing PPC after RKA included being treated at a large hospital (OR=1.22, P<0.001), non-emergency/elective admission (OR=0.23, P<0.001), treatment at a teaching hospital (OR=0.23, P<0.001), advanced age (OR=1.20, P<0.001), alcohol abuse (OR=1.64, P<0.001), nutritional anemia (OR=1.26, P<0.001), congestive heart failure (OR=2.51, P<0.001), chronic lung disease (OR=1.78, P<0.001), coagulation disorders (OR=2.25, P<0.001), fluid and electrolyte disorders (OR=4.34, P<0.001), metastatic cancer (OR=2.39, P<0.001), neurological disorders (OR=4.76, P<0.001), obesity (OR=1.50, P<0.001), paralysis (OR=2.10, P<0.001), peripheral vascular disease (OR=1.37, P<0.001), pulmonary circulation disorders (OR=2.61, P<0.001), renal failure (OR=1.21, P<0.001), weight loss (malnutrition) (OR=2.99, P<0.001), deep vein thrombosis (OR=6.09, P<0.001), postoperative delirium (OR=4.84, P<0.001), heart failure (OR=1.19, P<0.001), sepsis (OR=12.91, P<0.001), and wound dehiscence (OR=1.13, P<0.001). Conclusion The incidence of pulmonary complications after revision knee arthroplasty is relatively low. Early examination and identification of risk factors related to postoperative pulmonary complications can help make appropriate treatment in advance and mitigate the consequences.

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备注/Memo

备注/Memo:
基金项目：南方医科大学2021年度高等教育教学改革项目（202131）融合课程思政的临床护理混合式教学实践改革
更新日期/Last Update: 2025-03-10