慢性腎臟病對全髖關節置換術病患預後情形之影響

Impact of chronic kidney disease on outcome of total hip replacement patients

張祺君(Chi-Chun Chang) ； 陳威明(Wei-Ming Chen) ； 陳正豐(Cheng-Fong Chen) ； 吳肖琪(Shiao-Chi Wu)

《台灣公共衛生雜誌》 35卷1期 (2016/02) Pp. 53-65

https://doi.org/10.6288/TJPH201635104066

摘要

目標：慢性腎臟病病患因腎性骨病變導致骨密度變低，故全髖關節置換術發生率高於常人，且慢性腎臟病病患因免疫系統失調較容易發生感染，但目前國內缺乏慢性腎臟病病患接受全髖關節置換術預後情形之相關研究，故本研究之目的為探討慢性腎臟病對全髖關節置換術預後之影響。方法：採用回溯性世代研究法，以全民健保2009年至2011年接受全髖關節置換術之成年病患為研究對象，以術前一年是否罹患慢性腎臟病，區分為慢性腎臟病組及無慢性腎臟病組。本研究使用邏輯斯迴歸計算病患罹患慢性腎臟病之傾向分數後進行配對，並以Cox proportional hazard model進行分析。結果：慢性腎臟病病患接受全髖關節置換術後90日內感染、再住院及死亡發生率與風險皆顯著高於腎功能正常者。結論：慢性腎臟病病患接受全髖關節置換術後，感染、再住院與死亡風險均較腎功能正常者高。建議醫院加強照護接受全髖關節置換術之慢性腎臟病病患，多留意易造成感染之因素；骨科醫師應於術前評估時，向慢性腎臟病病患說明其術後發生併發症之風險較高。

關鍵字

慢性腎臟病 ； 全髖關節置換術 ； 醫療品質

並列摘要

Objectives: Chronic kidney disease (CKD) has been shown to cause osteoporosis because of renal bone disease, thus CKD patients are at higher risk for total hip replacement (THR) than patients without CKD; however, there are few studies which have determined whether or not the outcomes are positive or negative when CKD patients undergo THR. Therefore, the aim of this study was to explore the influence of CKD on THR patient outcomes. Methods: The study adopted a retrospective cohort study design, and the subjects were adult THR patients. Data were derived from the National Health Insurance Research Database between 2009 and 2011. According to the patients who did or did not have CKD the year prior to the THR, the patients were divided into two groups (CKD and non-CKD groups), and a propensity score was used to match subjects. Cox proportional hazards regression was used to analyze the outcomes. Results: In the CKD group, the 90-day post-operative infection, readmission, and death rates were higher than the non- CKD group. The 90-day post-operative infection (AHR=1.8), readmission (AHR=1.9), and death risk (AHR=3.5) in the CKD group were also higher than the non-CKD group. Conclusions: CKD patients have higher risks of 90-day post-operative infections, re-admission, and death than people without CKD after THR. Health authorities and medical institutions should strengthen the care for patients with CKD receiving THR to reduce the likelihood of adverse outcomes.

並列關鍵字

chronic kidney disease ； total hip replacement ； surgery outcome

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