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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 57 -63. doi: 10.3877/cma.j.issn.1674-134X.2021.01.010

所属专题: 文献

临床论著

美国住院病人髋膝关节置换术后谵妄发生率及危险因素
杨钦烽1, 王健1, 张洋1,(), 史占军1, 徐一川1, 陈雨航1, 廉强1   
  1. 1. 510515 广州,南方医科大学南方医院关节与骨病外科
  • 收稿日期:2020-06-08 出版日期:2021-02-01
  • 通信作者: 张洋

Incidence and risk factors of postoperative delirium following total joint arthroplasty based on USA Nationwide Inpatient Sample

Qinfeng Yang1, Jian Wang1, Yang Zhang1,(), Zhanjun Shi1, Yichuan Xu1, Yuhang Chen1, Qiang Lian1   

  1. 1. Department of Orthopaedic Surgery, Division of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2020-06-08 Published:2021-02-01
  • Corresponding author: Yang Zhang
引用本文:

杨钦烽, 王健, 张洋, 史占军, 徐一川, 陈雨航, 廉强. 美国住院病人髋膝关节置换术后谵妄发生率及危险因素[J/OL]. 中华关节外科杂志(电子版), 2021, 15(01): 57-63.

Qinfeng Yang, Jian Wang, Yang Zhang, Zhanjun Shi, Yichuan Xu, Yuhang Chen, Qiang Lian. Incidence and risk factors of postoperative delirium following total joint arthroplasty based on USA Nationwide Inpatient Sample[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(01): 57-63.

目的

探讨基于大样本量的髋膝关节置换(TJA)术后谵妄的发生率及危险因素。

方法

基于2005~2014年美国的全国住院病人样本(NIS)数据库进行了回顾性分析。分别纳入并分析行全髋关节置换术(THA)和全膝关节置换术(TKA)且在2005~2014年NIS数据库中信息完整的病例。排除年龄不足18岁、急诊入院、合并骨骼感染或病理性骨折的病例。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(LOS)、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TJA术后谵妄发作的危险因素。

结果

共纳入1 821 924例患者,其中包括593 045例THA和1 228 879例TKA。TJA术后谵妄的总体发生率为0.99%,于2008年达到峰值,此后逐渐下降。出现TJA术后谵妄的患者呈现出更多的合并症(Z=127.86、13.84,均为P<0.01)、更长的LOS(Z=127.82、19.33,均为P<0.01)、较高的住院费用(Z=128.10、14.64,均为P<0.01)以及住院期间死亡率(χ2=102.52、44.58,均为P<0.01)。高龄、合并神经系统疾病、酒精及药物滥用、抑郁症、精神病、水电解质紊乱、糖尿病、体重减轻、营养性或慢性失血性贫血、凝血功能障碍、转移癌、高血压、充血性心力衰竭、肺循环功能障碍、心脏瓣膜病、外周血管疾病以及肾衰竭病史是TJA术后谵妄的独立危险因素。女性、黑人和肥胖则是TJA术后谵妄保护因素。

结论

TJA术后谵妄的整体发生率较低,但常导致严重的后果。掌握术后谵妄的危险因素有助于制定合适的围术期管理方案并改善预后。

Objective

To explore the incidence and risk factors of delirium after total joint arthroplasty (TJA) using a large-scale national database.

Methods

A retrospective analysis was performed based on Nationwide Inpatient Sample (NIS) database of the United States from 2005~2014. The patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) with available hospitalized information registered in NIS database from 2005 to 2014 were included and analyzed separately. The patients who were less than 18 years of age, were non-elective admission, had osteomyelitis, or had pathologic fracture were excluded from this study. Patient demographics, comorbidities, length of stay (LOS), total charges, and in-hospital mortality were evaluated by Wilcoxon rank test for continuous data and chi-square test for categorical data. Logistic regression was performed to identify risk factors of delirium following TJA.

Results

A total of 1 821 924 TJAs were obtained from the NIS database, including 593 045 THAs and 1 228 879 TKAs. The general incidence of delirium after TJA was 0.99%, which peaked in the year 2008. The patients with delirium after TJA presented more comorbidities(Z=127.86、13.84, both P<0.01), increased LOS (Z=127.82, 19.33, both P<0.01), extra hospital charges(Z=128.10, 14.64, both P<0.01), and higher in-hospital mortality(χ2=102.52, 44.58, both P<0.01). Independent risk factors of delirium following TJA included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency or chronic blood loss anemia, coagulopathy, metastatic cancer, hypertension, congestive heart failure, pulmonary circulation disorders, valvular disease, peripheral vascular disorders, and renal failure. Female, black and obesity were detected to be protective factors.

Conclusions

A relatively low incidence is identified, but the occurrence of delirium after TJA usually cause a variety of severe effects. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate perioperative management and moderate its consequences.

表1 纳入logistic回归分析的变量
表2 TJA术后谵妄患者的临床特征和结局(2005~2014)
图1 术后谵妄的历年发生率
表3 术后谵妄的危险因素(2005~2014)
变量 THA TKA
OR 95% CI P OR 95% CI P
年龄≥ 61岁 4.78 (4.30,5.33) <0.01 4.39 (4.07,4.73) <0.01
女性 0.83 (0.78,0.89) <0.01 0.82 (0.78,0.85) <0.01
种族            
  白人 - - - - - -
  黑人 0.82 (0.71,0.94) <0.01 0.88 (0.80,0.96) <0.01
  西班牙人 0.81 (0.67,0.99) 0.03 0.82 (0.74,0.90) <0.01
  亚洲人或太平洋岛国人 0.91 (0.65,1.27) 0.56 0.82 (0.68,1.00) 0.05
  美国本土人 0.77 (0.43,1.38) 0.38 0.84 (0.61,1.16) 0.30
  其他人种 0.86 (0.68,1.09) 0.21 0.92 (0.80,1.06) 0.27
医院病床规模            
  - - - - - -
  0.95 (0.87,1.04) 0.26 0.94 (0.89,1.00) 0.06
  0.92 (0.85,0.99) 0.04 0.93 (0.88,0.98) <0.01
教学医院 1.08 (1.02,1.15) 0.01 1.11 (1.07,1.16) <0.01
城市医院 0.89 (0.81,0.98) 0.02 0.85 (0.80,0.91) <0.01
艾滋病 0.77 (0.25,2.42) 0.65 0.72 (0.10,5.26) 0.75
酒精滥用(酗酒) 1.89 (1.59,2.24) <0.01 2.64 (2.31,3.01) <0.01
营养性贫血 1.31 (1.22,1.41) <0.01 1.41 (1.34,1.48) <0.01
类风湿关节炎/胶原血管疾病 0.90 (0.78,1.05) 0.20 1.02 (0.93,1.13) 0.65
慢性失血性贫血 1.34 (1.12,1.60) <0.01 1.59 (1.40,1.79) <0.01
充血性心力衰竭 1.72 (1.54,1.92) <0.01 1.77 (1.63,1.92) <0.01
慢性肺疾病 1.04 (0.96,1.13) 0.30 1.14 (1.08,1.20) <0.01
凝血功能障碍 1.37 (1.20,1.57) <0.01 1.64 (1.49,1.80) <0.01
抑郁症 1.42 (1.31,1.54) <0.01 1.33 (1.26,1.40) <0.01
无并发症的糖尿病 1.19 (1.10,1.29) <0.01 1.15 (1.10,1.21) <0.01
伴有慢性并发症的糖尿病 1.64 (1.37,1.95) <0.01 1.77 (1.60,1.96) <0.01
药物滥用 2.53 (1.97,3.25) <0.01 2.06 (1.66,2.56) <0.01
高血压 1.21 (1.13,1.30) <0.01 1.12 (1.07,1.18) <0.01
甲状腺功能减退症 1.06 (0.98,1.15) 0.15 1.01 (0.96,1.07) 0.63
肝脏疾病 1.18 (0.92,1.51) 0.18 1.14 (0.94,1.37) 0.18
淋巴瘤 1.67 (1.19,2.33) <0.01 1.08 (0.77,1.54) 0.65
水电解质紊乱 2.44 (2.28,2.62) <0.01 2.48 (2.36,2.61) <0.01
转移癌 1.82 (1.28,2.59) <0.01 1.95 (1.23,3.11) <0.01
神经系统疾病 7.57 (7.06,8.12) <0.01 8.69 (8.29,9.11) <0.01
肥胖 0.72 (0.65,0.79) <0.01 0.72 (0.68,0.76) <0.01
瘫痪 1.23 (0.90,1.67) 0.19 1.19 (0.92,1.55) 0.19
外周血管疾病 1.38 (1.22,1.57) <0.01 1.46 (1.32,1.61) <0.01
精神病 1.97 (1.70,2.28) <0.01 2.28 (2.07,2.50) <0.01
肺循环功能障碍 1.55 (1.29,1.86) <0.01 1.53 (1.34,1.74) <0.01
肾衰竭 1.38 (1.24,1.52) <0.01 1.50 (1.39,1.61) <0.01
未转移的实体肿瘤 1.10 (0.82,1.49) 0.53 1.47 (1.17,1.84) <0.01
消化性溃疡病 2.26 (0.68,7.53) 0.18 1.43 (0.52,3.95) 0.49
心脏瓣膜病 1.36 (1.22,1.52) <0.01 1.26 (1.16,1.37) <0.01
体重减轻(营养不良) 1.62 (1.33,1.97) <0.01 2.18 (1.77,2.68) <0.01
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