摘要
目的:分析加速康复外科(ERAS)模式下初次全膝关节置换术(TKA)患者住院时间延长的危险因素.方法:回顾性分析2020年1月至2023年12月无锡市第九人民医院围手术期严格执行ERAS措施行初次TKA的260例患者的临床资料.住院时间≥5 d定义为住院时间延长.其中住院时间延长组88例患者(33.8％),住院时间正常组172例患者(66.2％).记录并比较两组患者一般情况、合并基础疾病及病史、手术相关指标.采用多因素logistic回归分析ERAS模式下初次TKA患者住院时间延长的危险因素.结果:两组患者性别、年龄、体重指数(BMI)、有无吸烟、术前美国麻醉医师协会(ASA)分级、有无心力衰竭(CF)史、有无脑血管意外(CVA)史、手术医师差异均无统计学意义(P均>0.05);住院时间延长组患者术前血红蛋白(Hb)水平低于住院时间正常组患者,糖尿病(DM)患者占比、有心肌缺血性疾病(IHD)史患者占比、围手术期输血率均高于住院时间正常组患者,手术时间长于住院时间正常组患者,且差异均有统计学意义(P均<0.05).多因素logistic回归分析结果显示,年龄>70岁[优势比(OR)=2.517,95％置信区间(95％CI):1.051～6.030,P=0.038]、有IHD史(OR=0.194,95％CI:0.022～0.793,P=0.047)、手术时间>90 min(OR=2.230,95％CI:1.190～4.181,P=0.012)是ERAS模式下初次TKA患者住院时间延长的危险因素.结论:年龄>70岁、有IHD史、手术时间>90 min是ERAS模式下初次TKA患者住院时间延长的危险因素.
Abstract
Objective:To investigate the risk factors for prolonged hospital stays in patients undergoing primary total knee arthroplasty (TKA) following the enhanced recovery after surgery (ERAS) protocol. Methods:A retrospective analysis was performed on the clinical data of 260 patients who underwent primary TKA with strict implementation of ERAS measures at Wuxi Ninth People's Hospital from January 2020 to December 2023. A hospital stay of ≥5 days was defined as prolonged. Among these patients,88 (33.8％) were categorized in the prolonged stay group,while 172 (66.2％) were in the normal stay group. Demographic information,comorbidities,medical history,and surgery indicators were recorded and compared between the two groups. Multivariate logistic regression analysis was used to identify the risk factors for prolonged hospital stays in TKA patients following the ERAS protocol. Results:There were no significant differences between the two groups in gender,age,body mass index,smoking history,preoperative American Society of Anesthesiologists grade,history of cardiac failure,history of cerebrovascular accident,or operating surgeon (all P>0.05). However,the prolonged stay group showed significantly lower preoperative hemoglobin levels,higher proportions of diabetes mellitus and history of ischemic heart disease (IHD),higher perioperative blood transfusion rates,and longer surgery durations compared to the normal stay group (all P<0.05). Multivariate logistic regression analysis revealed that age>70 years (odds ratio[OR]=2.517,95％ confidence interval[95％CI]:1.051-6.030,P=0.038),a history of IHD (OR=0.194,95％CI:0.022-0.793,P=0.047),and surgery duration>90 minutes (OR=2.230,95％CI:1.190-4.181,P=0.012) were risk factors for prolonged hospital stays in TKA patients following the ERAS protocol. Conclusions:Age>70 years,a history of IHD,and surgery duration>90 minutes are risk factors for prolonged hospital stays in patients undergoing primary TKA following the ERAS protocol.
维普
万方数据