美国住院病人髋膝关节置换术后谵妄发生率及危险因素

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...

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

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.ResultsA total of 1821924 TJAs were obtained from the NIS database,including 593045 THAs and 1228879 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.