术前抑郁对全膝置换的影响:回顾性数据库分析

Impact of preoperative depression on total knee arthroplasty: A retrospective database analysis

摘要:

[目的] 通过 PearlDiver 数据库的大数据，分析术前抑郁对全膝关节置换 （total knee arthroplasty, TKA） 术后结果的影响。[方法] 从 PearlDiver 数据库中检索和匹配选择 2010—2022 年初次接受 TKA 手术的抑郁组和非抑郁组患者各 126 513 例， 通过多变量回归分析比较两组患者术后 90 d 内的内科并发症及术后 5 年内的外科并发症。[结果]抑郁组在 TKA 术后 90 d 内的肺炎 [例 (%), 1 766 (1.4) vs 1 225 (1.0), P＜0.001]、脑血管意外 [929 (0.7) vs 657 (0.5), P＜0.001]、深静脉血栓 [3 057 (2.4) vs 2 738 (2.2), P＜0.001]、输血 [3 213 (2.5) vs 2 518 (2.0), P＜0.001]、急性肾损伤 [2 214 (1.8) vs 1 859 (1.5), P＜0.001]、尿路感染 [6 388 (5.1) vs 4 855 (3.8), P＜0.001]、败血症 [902 (0.7) vs 575 (0.5), P＜0.001]、伤口并发症发生率 [1 667 (1.3) vs 1 226 (1.0), P＜0.001] 显著高于非抑郁组。术后 90 d、术后 1 年、术后 2 年、术后 5 年抑郁组 TKA 假体周围关节感染、假体不稳定、假体周围骨折、翻修的发生率显著高于非抑郁组（P＜0.001）。术后 90 d 内抑郁组的急诊就诊率和再入院率显著高于非抑郁组（P＜0.001）。术后 1、2、5 年抑郁组无菌性松动的发生率显著高于非抑郁组（P＜0.001）。术后 90 d、1 年、2 年和 5 年，抑郁组麻醉下关节松解（manipulation under an- esthesia, MUA） 的数量显著少于非抑郁组 （P＜0.001）。术后 90 d 两组无菌性松动的发生率差异无统计学意义 （P=0.042）。[结论]TKA 术前抑郁伴随较高的内科和外科并发症风险相关，应仔细评估，并采取更好的围手术期计划和更详细的术后管理，以提高手术效果。

Abstract:

[Objective] To assess the impact of depression on total knee arthroplasty (TKA) outcomes by using the large-scale PearlDiv-er database. [Methods] A total of 126 513 patients with depression and 126 513 patients without depression who underwent primary TKA between 2010 and 2022 were identified and matching selected from the PearlDiver database. Multivariable regression analysis was performed to compare medical complications within 90 days postoperatively and surgical complications within 5 years between the two groups. [Results] Within 90 days postoperatively, the depression group proved significantly higher than the non-depression group in terms of pneumonia incidences [n (%), 1 766 (1.40) vs 1 225 (0.97), P＜0.001], cerebrovascular accident [929 (0.7) vs 657 (0.5), P＜0.001], deep vein thrombosis [3 057 (2.4) vs 2 738 (2.2), P＜0.001], blood transfusion [3 213 (2.5) vs 2 518 (2.0), P＜0.001], acute kidney damage [2 214 (1.8) vs 1 859 (1.5), P＜0.001], urinary tract infection [6 388 (5.1) vs 4 855 (3.8), P＜0.001], sepsis [902 (0.7) vs 575 (0.5), P＜0.001] and wound complications [1 667 (1.3) vs 1 226 (1.0), P＜0.001]. In addition, the depression group was also significantly greater than the non-depression group in terms of incidence of periprosthetic joint infection, prosthesis instability, periprosthetic fracture and revision TKA 90 days, 1 year, 2 years and 5 years after surgery (P＜0.001). The depression group also had significantly higher chance of emergency department visits and readmission than the non-depression group within 90 days after surgery (P＜0.001). The depression group proved significantly higher incidence of aseptic loosening than the non-depression group 1, 2 and 5 years after surgery (P＜0.001). However, the depression group had significantly lower number of manipulation under anesthesia (MUA) than the non-depression group 90 days, 1 year, 2 years and 5 years after TKA (P＜0.001), and there were no a significant difference in the incidence of aseptic loosening between the two groups 90 days after surgery (P= 0.042). [Conclusion] The depression before TKA is associated with higher risk of medical and surgical complications, which should be evaluated carefully, and take better perioperative planning and more detailed post-operative management to improve surgical outcomes.