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免疫抑制剂异质性和整体关节整形术的结果:一个比较的队列研究
Ghulam Saadat1, Vivian Liang2, Joel Williams3
1John H. Stroger, Jr. Hospital of Cook County, Chicago, United States. ghulam.saadat@cookcountyhhs.org.
概括
慢性免疫抑制剂的使用增加了全关节整形术 (TJA) 后的主要并发症. 抗拒药物,组合疗法和皮质类固醇具有最高的风险,需要量身定制的患者管理策略.
科学领域:
- 整形外科手术 整形外科手术
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 整关节整形术 (TJA) 是一种成功的手术,但慢性免疫抑制治疗对其结果的影响尚不清楚.
- 这项研究调查了各种免疫抑制剂对TJA后重大术后并发症的影响.
研究的目的:
- 评估不同类别的免疫抑制药物对TJA患者重大术后并发症的异质效应.
- 确定与增加风险相关的特定免疫抑制疗法.
主要方法:
- 使用2022年国家外科质量改进计划数据库进行回顾性队列研究.
- 包括114,498名接受TJA的患者,按免疫抑制剂的使用分类 (抗拒,生物制剂,皮质类固醇,合成DMARD,组合疗法).
- 用多变量逻辑回归来评估主要的术后并发症作为综合结果.
主要成果:
- 4.4%的TJA患者 (5,018) 在慢性免疫抑制治疗中.
- 与非使用者 (6.37%) 相比,免疫抑制剂使用者的重大并发症发生率更高 (10.44%).
- 发现抗拒疗法 (aOR: 1.96),组合疗法 (aOR: 1.83) 和皮质类固醇 (aOR: 1.58) 的风险显著增加.
结论:
- 慢性免疫抑制剂的使用与TJA患者出现重大术后并发症的几率显著增加有关.
- 抗拒疗法,组合疗法和皮质类固醇具有最大的风险.
- 研究结果强调,需要优化外科手术期间风险分层,并为接受免疫抑制剂的TJA患者提供量身定制的管理.
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