评估全膝关节整形术患者的术后风险,并进行正常的术前心脏应力测试
Mehul M Mittal1, Terrul Ratcliff2, Varatharaj Mounasamy2,3
1Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas, TX, USA. Mehul.Mittal@UTSouthwestern.edu.
Archives of orthopaedic and trauma surgery
|December 12, 2024
概括
经过全膝关节整形术 (TKA) 和正常心脏应力测试的患者患心肌梗塞和肺炎等并发症的风险更高. 潜在的健康状况,而不是压力测试本身,可能表明术后风险增加.
科学领域:
- 整形外科手术 整形外科手术
- 心脏病学 心脏病学
- 在外科手术期间的医学.
背景情况:
- 大多数接受关节置换的患者不需要进行心脏应力测试.
- 患有心脏病的个体在全膝关节整形术 (TKA) 后可能面临增加的术后风险.
研究的目的:
- 分析初级TKA患者的手术后立即结果.
- 为了比较正常心脏应力测试的患者和没有手术前应力测试的患者之间的结果.
主要方法:
- 使用TriNetX研究网络进行的回顾性队列研究.
- 倾向性得分匹配与正常压力测试 (n=13,881) 和没有 (n=13,881) 的患者进行了比较.
- 从2003年1月1日到2024年1月1日分析的数据;P<0.01被认为是显著的.
主要成果:
- 正常压力测试队列显示,输血 (RR: 1.702),心肌梗塞 (MI) (RR: 1.908),急性功能衰竭 (ARF) (RR: 1.504),贫血 (RR: 1.245),伤口脱光 (RR: 1.549) 和肺炎 (RR: 2.051) 的30天风险显著增加.
- 这些高风险在90天的随访中仍然存在.
- 在匹配前观察到死亡风险增加 (RR: 2.115).
结论:
- 促使压力测试的潜在条件 (例如,心力衰竭,功能不全) 可能表明术后风险较高.
- 压力测试结果本身可能不是增加风险的唯一决定因素.
- 专注于先前存在的并发症对于管理TKA患者风险至关重要.
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