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慢性类固醇或免疫抑制疗法的风险在肩部全关节整形手术患者身上
Puneet Gupta1, Theodore Quan1, Melissa A Wright2,3
1Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Shoulder & elbow
|August 4, 2023
概括
在初级全肩关节整形手术前慢性皮质类固醇/免疫抑制剂的使用会增加尿路感染和败血性休克的风险. 患者和外科医生应考虑这些风险,以便明智作出决策.
科学领域:
- 整形外科手术 整形外科手术
- 患者安全 患者安全
- 免疫抑制管理管理
背景情况:
- 慢性皮质类固醇/免疫抑制剂 (SI) 患者在骨科手术中面临更高的风险.
- 术前SI使用对初级全肩关节整形术 (SA) 结果的具体影响仍未得到充分探索.
研究的目的:
- 调查慢性手术前SI使用与初级全肩关节整形手术 (SA) 中30天并发症之间的关联.
主要方法:
- 使用了国家外科质量改进计划 (NSQIP) 数据库 (2006-2019).
- 26,979名SA患者被分为SI使用者 (4.9%) 和非使用者.
- 进行双变量和多变量分析以评估并发症风险.
主要成果:
- 慢性手术前的SI使用与初级SA后尿路感染 (UTI) (OR 1.87) 和败血症休克 (OR 7.14) 的风险增加有关.
- 在SI用户和非用户之间没有观察到死亡率的显著差异 (p=0.058).
结论:
- 慢性手术前的SI使用是初级SA之后的败血性休克和尿路感染的独立风险因素.
- 强调需要对患者进行明智的咨询,并对手术前使用SI进行手术决策.
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