摘要
背景:人工髋膝关节置换术在老年群体中有广泛应用,但临床中缺乏对患者非计划再次入院和术后并发症的准确预测方法。目的:探讨罗斯曼(Rothman)指数对老年髋膝关节置换患者术后非计划再入院和并发症的影响。方法:选择合肥市第一人民医院骨科一病区2020年12月至2022年12月接受择期髋、膝关节手术患者153例为研究对象,根据出院后90 d内是否非计划再次入院分为再入院组(n=21)和非再入院组(n=132)。通过电子病历系统统计所有患者一般性资料,包括性别、年龄、体质量指数、合并糖尿病、合并高血压、手术关节类型等,参照文献评估Rothman指数,统计患者术后并发症。结果与结论:①再入院组和非再入院组患者性别、体质量指数、手术关节类型、住院时长比较差异无显著性意义(P>0.05),两组共病数量、年龄、Rothman得分比较差异有显著性意义(P<0.05);②多因素Logistics回归分析结果显示,共病数量、年龄和Rothman得分均是老年髋、膝关节疾病患者术后90 d再入院的独立影响因素(P<0.05);③受试者工作特征曲线分析结果表明,Rothman指数预测人工髋膝关节置换术后90 d再入院曲线下面积为0.824,敏感度为80.85%,特异度为78.85%,最大youden指数为0.597,最佳截断值为46分;④Rothman<46分的老年患者总并发症发生率高于Rothman≥46分的老年患者(P<0.05);⑤提示Rothman指数可较为准确地预测老年髋、膝关节疾病患者术后非计划再入院,同时Rothman指数低于46分者发生并发症总体风险较高,关节恢复较差,可用于临床中改善患者术后管理。
BACKGROUND:Total hip and knee arthroplasty is widely used in the elderly population,but there is a lack of accurate prediction methods for unplanned readmission and postoperative complications.OBJECTIVE:To investigate the effect of the Rothman index on unplanned readmission and complications in elderly patients undergoing total hip and knee arthroplasty.METHODS:A total of 153 patients who underwent elective total hip and knee arthroplasty from December 2020 to December 2022 in Ward Area One,Department of Orthopedics,The First People’s Hospital of Zunyi were selected as the study subjects.According to whether they were unplanned readmission within 90 days after discharge,they were divided into a readmission group(n=21)and a non-readmission group(n=132).The general data of all patients were collected through the electronic medical record system,including gender,age,body mass index,diabetes mellitus,hypertension,and surgical joint type.The Rothman index was evaluated according to the literature.Postoperative complications were counted.RESULTS AND CONCLUSION:(1)There was no significant difference in gender,body mass index,surgical joint type,and length of hospital stay between the readmission group and the non-readmission group(P>0.05).There were significant differences in the number of comorbidities,age,and Rothman score between the two groups(P<0.05).(2)The results of multivariate Logistics regression analysis showed that the number of comorbidities,age,and Rothman score were independent influencing factors for readmission 90 days after total hip and knee arthroplasty in elderly patients with hip and knee diseases(P<0.05).(3)The results of receiver operating characteristic curve analysis exhibited that the area under the curve of the Rothman index for predicting readmission 90 days after total hip and knee arthroplasty was 0.824;the sensitivity was 80.85%;the specificity was 78.85%;the maximum Youden index was 0.597,and the optimal cutoff value was 46 points.(4)The incidence of total complications in elderly patients with Rothman<46 was higher than that in elderly patients with Rothman≥46(P<0.05).(5)It is concluded that the Rothman index can accurately predict unplanned readmission after total hip and knee arthroplasty in elderly patients with hip and knee joint diseases.Simultaneously,patients with Rothman index of less than 46 points have a higher overall risk of complications and poor joint recovery,which can be used to improve postoperative management of patients in clinical practice.
作者
周思睿
黄坤
柏帆
刘利
周阳
Zhou Sirui;Huang Kun;Bai Fan;Liu Li;Zhou Yangyang(The First People’s Hospital of Zunyi,Zunyi 563000,Guizhou Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2024年第18期2835-2839,共5页
Chinese Journal of Tissue Engineering Research
基金
合肥市科技计划项目[遵市科合HZ(2022)85号],项目负责人:黄坤。
