Investigation and characteristic analysis on comorbidities in elderly patients with total hip/knee arthroplasty_West China Medical Journal

Authors：

ZHANG Hongying ^1,2 ,  NING Ning ¹ ,  CHEN Jiali ¹ , LI Peifang ¹ , XIE Jingying ¹

1. West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Orthopedics, Second People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding author：

NING Ning, Email: gkningning@126.com; CHEN Jiali, Email: cjl85614115@163.com

Keywords：

Arthroplasty; Elderly patients; Comorbidities

DOI：

10.7507/1002-0179.202007265

Video：

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Objective To investigate and analyze comorbidities of elderly patients with total hip/knee arthroplasty, so as to provide a basis for the management of comorbidities.Methods Convenience sampling was used to select elderly patients who underwent total hip/knee arthroplasty in the Department of Orthopedics in West China Hospital of Sichuan University from June to December 2019 as the research objects. We collected general data and comorbidity data of patients, and statistically analyzed the comorbidities of elderly patients undergoing total hip/knee arthroplasty, and the characteristics of perioperative psychology, sleep, postoperative complications, and length of hospital stay in elderly patients undergoing total hip/knee arthroplasty with comorbidities.Results A total of 263 patients were included, of whom 64.6% had comorbidities. The number of comorbidities in elderly patients undergoing total hip/knee arthroplasty ranged from 2 to 12. The most common comorbidity was hypertension. Between patients with comorbidities and non-comorbidities, there were statistically significant differences in age (Z=−2.225, P=0.026), preoperative Huaxi Emotion Index scores (9.6±4.6 vs. 6.4±5.0; t=5.126, P<0.001), preoperative Pittsburgh Sleep Quality Index scores (13.3±3.1 vs. 12.3±2.5; t=−2.972, P=0.003), hospital stay [(5.2±0.8) vs. (4.8±0.4) d; t=4.243, P<0.001], and incidence of postoperative complications (13.5% vs. 5.4%; χ²=4.201, P=0.040).Conclusions Comorbidities are common in elderly patients with total hip/knee arthroplasty, which may aggravate negative emotions, reduce sleep quality, increase postoperative complications and prolong length of stay. Medical staff should strengthen the management of comorbidity in elderly patients with total hip/knee arthroplasty, so as to reduce its influence on perioperative period and promote the rehabilitation of patients.

Citation： ZHANG Hongying, NING Ning, CHEN Jiali, LI Peifang, XIE Jingying. Investigation and characteristic analysis on comorbidities in elderly patients with total hip/knee arthroplasty. West China Medical Journal, 2020, 35(10): 1195-1200. doi: 10.7507/1002-0179.202007265 Copy

1.	Stewart SP. Joint replacement and rapid mobilization: a clinical perspective on rapid arthroplasty mobilization protocol. Orthop Nurs, 2012, 31(4): 224-229.
2.	van Steenbergen LN, Denissen GA, Spooren A, et al. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop, 2015, 86(4): 498-505.
3.	尹志强, 潘惟丽, 金昊, 等. 骨性关节炎病因的研究进展. 现代生物医学进展, 2016, 16(7): 1369-1371, 1389.
4.	彭晨健. 老年髋膝骨关节炎患者关节置换术后并发症发生的影响因素分析. 南京: 南京中医药大学, 2019: 55.
5.	付丽英. 社区老年人慢性病共病及其对卫生服务利用的影响. 开封: 河南大学, 2019: 86.
6.	van den Bussche H, Koller D, Kolonko T, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health, 2011, 11: 101.
7.	Islam MM, Valderas JM, Yen L, et al. Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns. PLoS One, 2014, 9(1): e83783.
8.	范利. 我国老年人慢性病防控迫在眉睫. 中国临床保健杂志, 2019, 22(4): 433-434.
9.	赵明中, 胡大一, 彭晓霞. 老年患者共病及其管理. 中华老年医学杂志, 2015, 34(12): 1364-1367.
10.	Ferner RE, Aronson JK. Communicating information about drug safety. BMJ, 2006, 333(7559): 143-145.
11.	陈佳丽, 宁宁, 屈俊宏, 等. 骨科加速康复外科新视角. 华西医学, 2018, 33(9): 1068-1072.
12.	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016(2): 65-71.
13.	徐倩. 老年住院患者共病与多重用药的分析. 昆明: 昆明医科大学, 2017: 44.
14.	代明彬, 吕洋. 老年人合理用药策略的研究进展. 中华老年医学杂志, 2016, 35(1): 100-104.
15.	刘珊珊, 郑儒君, 李俊英, 等. 华西心晴指数在肿瘤科护士心理状况测定中的应用. 四川医学, 2017, 38(11): 1330-1335.
16.	孟宪东, 高猛, 李涛, 等. 华西心情指数量表在护理人员中应用的信度与效度研究. 中国护理管理, 2017, 17(3): 310-312.
17.	路桃影, 李艳, 夏萍, 等. 匹兹堡睡眠质量指数的信度及效度分析. 重庆医学, 2014(3): 260-263.
18.	彭志鹏, 张星平, 陈俊逾, 等. 基于匹兹堡睡眠质量指数的脾不藏意型及肾不藏志型不寐患者睡眠质量比较的临床研究. 上海中医药杂志, 2020, 54(4): 65-67.
19.	赵瑞敏. 某院住院患者多病共存情况调查分析. 太原: 山西医科大学, 2016: 37.
20.	闫巍, 李瑞, 王杰萍, 等. 北京市某三级医院综合科老年共病住院患者临床特点分析. 中国全科医学, 2018, 21(14): 1648-1656.
21.	崔娟, 毛凡, 王志会. 中国老年居民多种慢性病共存状况分析. 中国公共卫生, 2016, 32(1): 66-69.
22.	陈建民, 贾小宝, 鲍磊, 等. 全髋关节置换术后伤口延迟愈合与高血压的相关性研究. 中国矫形外科杂志, 2017, 25(10): 865-869.
23.	常承婷, 宁宁. 全髋关节置换术外科伤口感染的危险因素研究进展. 华西医学, 2019, 34(9): 1059-1062.
24.	刘春, 钱志刚, 孙启才. 腰椎滑脱症术后伤口感染危险因素分析. 中国骨伤, 2019, 32(10): 882-885.
25.	焦申军, 耿丽娟. 老年患者多药共用的原因及管理对策. 中国当代医药, 2018, 25(31): 171-173.
26.	李旭, 于军. 老年人合理用药分析. 中国老年学杂志, 2019, 39(7): 1789-1791.
27.	周双, 向倩. 系列问答142—为什么非甾体类抗炎药与抗凝药联合应用有潜在风险?. 药物不良反应杂志, 2018, 20(5): 400.
28.	Wong SY, Mercer SW, Woo J, et al. The influence of multi-morbidity and self-reported socio-economic standing on the prevalence of depression in an elderly Hong Kong population. BMC Public Health, 2008, 8: 119.
29.	Gahlan D, Rajput R, Gehlawat P, et al. Prevalence and determinants of diabetes distress in patients of diabetes mellitus in a tertiary care centre. Diabetes Metab Syndr, 2018, 12(3): 333-336.
30.	张晨, 宋国瑞, 刘子歌, 等. ERAS在老年人工关节置换术中的应用进展. 宁夏医科大学学报, 2020, 42(2): 211-214.
31.	Häfner S, Baumert J, Emeny RT, et al. Hypertension and depressed symptomatology: a cluster related to the activation of the renin-angiotensin-aldosterone system (RAAS). Findings from population based KORA F4 study. Psychoneuroendocrinology, 2013, 38(10): 2065-2074.
32.	Maraldi C, Volpato S, Penninx BW, et al. Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. Arch Intern Med, 2007, 167(11): 1137-1144.
33.	de Jonge P, Roy JF, Saz P, et al. Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus: results from the ZARADEMP project. Diabetologia, 2006, 49(11): 2627-2633.
34.	Wallace K, Zhao X, Misra R, et al. The humanistic and economic burden associated with anxiety and depression among adults with comorbid diabetes and hypertension. J Diabetes Res, 2018, 2018: 4842520.
35.	王玉珠, 柳莹, 李晓宇, 等. 关节置换患者围手术期睡眠质量及影响因素研究. 中华骨与关节外科杂志, 2020, 13(4): 312-318.
36.	Horsten S, Reinke L, Absalom AR, et al. Systematic review of the effects of intensive-care-unit noise on sleep of healthy subjects and the critically ill. Br J Anaesth, 2018, 120(3): 443-452.
37.	王宗芳. 老年糖尿病患者睡眠质量现状调查及其自我管理行为的相关性分析. 护理实践与研究, 2019, 16(24): 14-16.
38.	郭建联, 魏世超, 陈彦青, 等. 围术期睡眠障碍的研究进展. 中华麻醉学杂志, 2019, 39(10): 1276-1280.
39.	罗政, 高艳红, 皮红英. 老年慢性阻塞性肺疾病患者睡眠质量及相关影响因素分析. 解放军医学院学报, 2019, 40(6): 509-512.
40.	Khanijow V, Prakash P, Emsellem HA, et al. Sleep dysfunction and gastrointestinal diseases. Gastroenterol Hepatol (N Y), 2015, 11(12): 817-825.
41.	雷建国, 陈善萍, 杨永学. 衰弱与老年人腹腔镜术后快速康复相关性探讨. 中华老年医学杂志, 2018, 37(1): 62-66.
42.	张微微, 孟慧杰, 谢吉科, 等. 210例老年择期手术患者术前用药情况评价及药物重整. 中国药房, 2019, 30(1): 110-114.
43.	马俊, 沈彬, 杨静, 等. 人工全髋关节置换术后下肢深静脉血栓形成的危险因素分析. 中国矫形外科杂志, 2009, 17(13): 965-969.
44.	徐建圆, 钭晓帆, 余双娟. 老年髋部骨折围手术期深静脉血栓形成影响因素分析. 浙江创伤外科, 2020, 25(1): 115-116.
45.	彭浩, 梁笃, 李保林, 等. 查尔森合并症指数与老年股骨转子间骨折住院时间及费用的相关性研究. 中医药临床杂志, 2019, 31(5): 995-997.
46.	Nikkel LE, Fox EJ, Black KP, et al. Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am, 2012, 94(1): 9-17.
47.	顾红霞. 老年骨科住院患者医院感染危险因素的研究. 天津: 天津医科大学, 2014: 58.
48.	武芳, 伍祥林, 刘海霞. 合理缩短术前平均住院时间的可控影响因素及对策研究. 重庆医学, 2016, 45(19): 2717-2719.
49.	裴福兴. 加速康复外科是现代骨外科发展的趋势. 中国骨与关节杂志, 2017, 6(12): 881-882.
50.	李寅翠, 刘云. 全膝关节置换患者三联预康复的研究进展. 护理与康复, 2020, 19(5): 28-31.
51.	陶崎峰, 罗振宇, 周宗科, 等. 医用耗材取消加成对人工全膝关节置换术费用影响研究. 中国修复重建外科杂志, 2020, 34(2): 196-199.

1. Stewart SP. Joint replacement and rapid mobilization: a clinical perspective on rapid arthroplasty mobilization protocol. Orthop Nurs, 2012, 31(4): 224-229.
2. van Steenbergen LN, Denissen GA, Spooren A, et al. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop, 2015, 86(4): 498-505.
3. 尹志强, 潘惟丽, 金昊, 等. 骨性关节炎病因的研究进展. 现代生物医学进展, 2016, 16(7): 1369-1371, 1389.
4. 彭晨健. 老年髋膝骨关节炎患者关节置换术后并发症发生的影响因素分析. 南京: 南京中医药大学, 2019: 55.
5. 付丽英. 社区老年人慢性病共病及其对卫生服务利用的影响. 开封: 河南大学, 2019: 86.
6. van den Bussche H, Koller D, Kolonko T, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health, 2011, 11: 101.
7. Islam MM, Valderas JM, Yen L, et al. Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns. PLoS One, 2014, 9(1): e83783.
8. 范利. 我国老年人慢性病防控迫在眉睫. 中国临床保健杂志, 2019, 22(4): 433-434.
9. 赵明中, 胡大一, 彭晓霞. 老年患者共病及其管理. 中华老年医学杂志, 2015, 34(12): 1364-1367.
10. Ferner RE, Aronson JK. Communicating information about drug safety. BMJ, 2006, 333(7559): 143-145.
11. 陈佳丽, 宁宁, 屈俊宏, 等. 骨科加速康复外科新视角. 华西医学, 2018, 33(9): 1068-1072.
12. 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016(2): 65-71.
13. 徐倩. 老年住院患者共病与多重用药的分析. 昆明: 昆明医科大学, 2017: 44.
14. 代明彬, 吕洋. 老年人合理用药策略的研究进展. 中华老年医学杂志, 2016, 35(1): 100-104.
15. 刘珊珊, 郑儒君, 李俊英, 等. 华西心晴指数在肿瘤科护士心理状况测定中的应用. 四川医学, 2017, 38(11): 1330-1335.
16. 孟宪东, 高猛, 李涛, 等. 华西心情指数量表在护理人员中应用的信度与效度研究. 中国护理管理, 2017, 17(3): 310-312.
17. 路桃影, 李艳, 夏萍, 等. 匹兹堡睡眠质量指数的信度及效度分析. 重庆医学, 2014(3): 260-263.
18. 彭志鹏, 张星平, 陈俊逾, 等. 基于匹兹堡睡眠质量指数的脾不藏意型及肾不藏志型不寐患者睡眠质量比较的临床研究. 上海中医药杂志, 2020, 54(4): 65-67.
19. 赵瑞敏. 某院住院患者多病共存情况调查分析. 太原: 山西医科大学, 2016: 37.
20. 闫巍, 李瑞, 王杰萍, 等. 北京市某三级医院综合科老年共病住院患者临床特点分析. 中国全科医学, 2018, 21(14): 1648-1656.
21. 崔娟, 毛凡, 王志会. 中国老年居民多种慢性病共存状况分析. 中国公共卫生, 2016, 32(1): 66-69.
22. 陈建民, 贾小宝, 鲍磊, 等. 全髋关节置换术后伤口延迟愈合与高血压的相关性研究. 中国矫形外科杂志, 2017, 25(10): 865-869.
23. 常承婷, 宁宁. 全髋关节置换术外科伤口感染的危险因素研究进展. 华西医学, 2019, 34(9): 1059-1062.
24. 刘春, 钱志刚, 孙启才. 腰椎滑脱症术后伤口感染危险因素分析. 中国骨伤, 2019, 32(10): 882-885.
25. 焦申军, 耿丽娟. 老年患者多药共用的原因及管理对策. 中国当代医药, 2018, 25(31): 171-173.
26. 李旭, 于军. 老年人合理用药分析. 中国老年学杂志, 2019, 39(7): 1789-1791.
27. 周双, 向倩. 系列问答142—为什么非甾体类抗炎药与抗凝药联合应用有潜在风险?. 药物不良反应杂志, 2018, 20(5): 400.
28. Wong SY, Mercer SW, Woo J, et al. The influence of multi-morbidity and self-reported socio-economic standing on the prevalence of depression in an elderly Hong Kong population. BMC Public Health, 2008, 8: 119.
29. Gahlan D, Rajput R, Gehlawat P, et al. Prevalence and determinants of diabetes distress in patients of diabetes mellitus in a tertiary care centre. Diabetes Metab Syndr, 2018, 12(3): 333-336.
30. 张晨, 宋国瑞, 刘子歌, 等. ERAS在老年人工关节置换术中的应用进展. 宁夏医科大学学报, 2020, 42(2): 211-214.
31. Häfner S, Baumert J, Emeny RT, et al. Hypertension and depressed symptomatology: a cluster related to the activation of the renin-angiotensin-aldosterone system (RAAS). Findings from population based KORA F4 study. Psychoneuroendocrinology, 2013, 38(10): 2065-2074.
32. Maraldi C, Volpato S, Penninx BW, et al. Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. Arch Intern Med, 2007, 167(11): 1137-1144.
33. de Jonge P, Roy JF, Saz P, et al. Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus: results from the ZARADEMP project. Diabetologia, 2006, 49(11): 2627-2633.
34. Wallace K, Zhao X, Misra R, et al. The humanistic and economic burden associated with anxiety and depression among adults with comorbid diabetes and hypertension. J Diabetes Res, 2018, 2018: 4842520.
35. 王玉珠, 柳莹, 李晓宇, 等. 关节置换患者围手术期睡眠质量及影响因素研究. 中华骨与关节外科杂志, 2020, 13(4): 312-318.
36. Horsten S, Reinke L, Absalom AR, et al. Systematic review of the effects of intensive-care-unit noise on sleep of healthy subjects and the critically ill. Br J Anaesth, 2018, 120(3): 443-452.
37. 王宗芳. 老年糖尿病患者睡眠质量现状调查及其自我管理行为的相关性分析. 护理实践与研究, 2019, 16(24): 14-16.
38. 郭建联, 魏世超, 陈彦青, 等. 围术期睡眠障碍的研究进展. 中华麻醉学杂志, 2019, 39(10): 1276-1280.
39. 罗政, 高艳红, 皮红英. 老年慢性阻塞性肺疾病患者睡眠质量及相关影响因素分析. 解放军医学院学报, 2019, 40(6): 509-512.
40. Khanijow V, Prakash P, Emsellem HA, et al. Sleep dysfunction and gastrointestinal diseases. Gastroenterol Hepatol (N Y), 2015, 11(12): 817-825.
41. 雷建国, 陈善萍, 杨永学. 衰弱与老年人腹腔镜术后快速康复相关性探讨. 中华老年医学杂志, 2018, 37(1): 62-66.
42. 张微微, 孟慧杰, 谢吉科, 等. 210例老年择期手术患者术前用药情况评价及药物重整. 中国药房, 2019, 30(1): 110-114.
43. 马俊, 沈彬, 杨静, 等. 人工全髋关节置换术后下肢深静脉血栓形成的危险因素分析. 中国矫形外科杂志, 2009, 17(13): 965-969.
44. 徐建圆, 钭晓帆, 余双娟. 老年髋部骨折围手术期深静脉血栓形成影响因素分析. 浙江创伤外科, 2020, 25(1): 115-116.
45. 彭浩, 梁笃, 李保林, 等. 查尔森合并症指数与老年股骨转子间骨折住院时间及费用的相关性研究. 中医药临床杂志, 2019, 31(5): 995-997.
46. Nikkel LE, Fox EJ, Black KP, et al. Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am, 2012, 94(1): 9-17.
47. 顾红霞. 老年骨科住院患者医院感染危险因素的研究. 天津: 天津医科大学, 2014: 58.
48. 武芳, 伍祥林, 刘海霞. 合理缩短术前平均住院时间的可控影响因素及对策研究. 重庆医学, 2016, 45(19): 2717-2719.
49. 裴福兴. 加速康复外科是现代骨外科发展的趋势. 中国骨与关节杂志, 2017, 6(12): 881-882.
50. 李寅翠, 刘云. 全膝关节置换患者三联预康复的研究进展. 护理与康复, 2020, 19(5): 28-31.
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Investigation and characteristic analysis on comorbidities in elderly patients with total hip/knee arthroplasty

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