고관절 수술 후 심혈관계 합병증의 위험 요소
Risk Factors for Cardiovascular Complications Following Hip Surgery
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목적: 고관절 수술을 받은 환자군에서 심혈관계 합병증의 발생 빈도와 발생에 기여하는 위험요소를 분석하고자 한다. 대상 및 방법: 1998년부터 2008년까지 11년간 고관절 치환술과 고관절 골절 수술을 받은 1,390명의 환자들 중 심혈관계 합병증의 유무에 따라 질병군과 대조군으로 구분하여 연령, 성별, 수술 종류, 양측성 수술 여부, 술전 심혈관계 질환의 과거력 유무 등에 따라 비교 분석하였다. 수술 후 심혈관계 합병증은 술후 재원기간 이내에 심근경색, 심부전, 불안정성 협심증, 부정맥, 증상성저혈압, 폐색전증의 발생 여부를 기준으로 판단하였다. 결과: 총 1,390명 중 43명(3.1%)에서 심혈관계 합병증이 발생하였으며 합병증에 의하여 입원기간 중 1명(0.07%)의 사망환자가 발생한 것으로 조사되었다. 환자의 연령이 증가할수록, 양측의 단계적 수술을 받은 환자에서, 술전 고혈압이나 관상동맥 폐쇄성 질환 또는 판막질환의 과거력이 있는 경우, ASA category 3에 해당되는 경우에 심혈관계 합병증의 발생률이 통계적으로 유의하게 높은 것으로 관찰되었다. 결론: 고령 환자들 및 양측의 단계적 고관절 수술 환자들의 술후 관리를 세심하게 하고 술전 고혈압조절과 관상동맥 폐쇄성 질환의 예방 및 약물치료를 철저히 하는 것이 고관절 술후 심혈관계 합병증의 빈도를 감소시키는데 도움이 될 것으로 판단된다.
Abstract
Purpose: This study was performed in order to analyze the incidence of postoperative cardiovascular complications in patients who had undergone hip surgery and to identify risk factors associated with these complications. Materials and Methods: A total of 1,390 patients who had undergone hip surgery from 1998 to 2008 were divided into case or control groups according to occurrence of postoperative cardiovascular complications. Both groups were sorted and analyzed by age, gender, mode of operation, bilaterality and history of preoperative cardiovascular disease. Postoperative cardiovascular complication was defined as having any condition including myocardial infarction, congestive heart failure, unstable angina, arrhythmia, hypotension, or pulmonary thromboembolism during the surgical admission period. Results: Forty three out of 1,390 patients(3.1%) experienced cardiovasucular complications and 1 patient (0.07%) died. Increasing patient age (P=0.001), history of bilateral hip surgery (P=0.000), hypertension (P=0.002), coronary artery disease (P=0.000) or valvular heart disease (P=0.010), and ASA category 3 (P=0.000) were all associated with significantly higher incidence of cardiovascular complications. Conclusion: Intensive preoperative management though adequate hypertension control and prevention of coronary artery occlusive disease for patients who are elderly or receiving bilateral operation will help decrease the incidence of postoperative cardiovascular complications after hip surgery.
참고문헌 (22)
- Mahomed NN, "Rates and outcomes of primary and revision total hip replacement in the United States medicare population", J Bone Joint Surg Am, 85-A, pp.27~32 (2003)
- Barrett J, "Survival following total hip replacement", J Bone Joint Surg Am, 87, pp.1965~1971 (2005)
- Bhattacharyya T, "Rate of and risk factors for acute inpatient mortality after orthopaedic surgery", J Bone Joint Surg Am, 84-A, pp.562~572 (2002)
- Katz JN, "Association between hospital and surgeon procedure volume and the outcomes of total knee Following Hip Surgery replacement", J Bone Joint Surg Am, 86-A, pp.1909~1916 (2004)
- Kahn RL, "Supraventricular tachyarrhythmias during total joint arthroplasty. Incidence and risk", Clin Orthop Relat Res, (296), pp.265~269 (1993)
- Polanczyk CA, "Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay", Ann Intern Med, 129, pp.279~285 (1998)
- Christians KK, "Postoperative atrial fibrillation in noncardiothoracic surgical patients", Am J Surg, 182, pp.713~715 (2001)
- Nazon D, "Critical care in orthopedic and spine surgery", Crit Care Clin, 19, pp.33~53 (2003)
- "Patient and hospital characteristics for CCS principal procedure category: arthroplasty of knee (surgical reconstruction or replacement of knee), hip replacement, total and partial. Healthcare cost and utilization project"[URL]
- David E, "Introduction to anesthesia. 9th ed", pp.18~19 (1997), WB Saunders
- White BL, "Rate of mortality for elderly patients after fracture of the hip in the 1980’s", J Bone Joint Surg Am, 69, pp.1335~1340 (1987)
- Kenzora JE, "Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications", Clin Orthop Relat Res, (186), pp.45~56 (1984)
- 고덕환, "고령 환자에서 고관절부 골절의 수술 후 사망률", 대한골절학회지, 19(2), pp.1~1 (2006), 대한골절학회
- Eiskjaer S, "Risk factors influencing mortality after bipolar hemiarthroplasty in the treatment of fracture of the femoral neck", Clin Orthop Relat Res, (270), pp.295~300 (1991)
- Kalra S, "Intracapsular hip fractures in end-stage renal failure", Injury, 37, pp.175~184 (2006)
- 배인탁, "만성 신질환 환자에서 발생한 고관절부 골절의 수술 후 합병증", Hip and Pelvis, 21(2), pp.169~173 (2009), 대한고관절학회
- Mantilla CB, "Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty", Anesthesiology, 96, pp.1140~1146 (2002)
- Basilico FC, "Risk factors for cardiovascular complications following total joint replacement surgery", Arthritis Rheum, 58, pp.1915~1920 (2008)
- Wolf LD, "Pulmonary embolism in total joint arthroplasty", Clin Orthop Relat Res, (288), pp.219~233 (1993)
- Wroblewski BM, "Fatal pulmonary embolism after total hip arthroplasty. Seasonal variation", Clin Orthop Relat Res, (276), pp.222~224 (1992)
- Ceder L, "Prognostic indicators and early home rehabilitation in elderly patients with hip fractures", Clin Orthop Relat Res, (152), pp.173~184 (1980)
- Owens WD, "ASA physical status classifications: a study of consistency of ratings", Anesthesiology, 49, pp.239~243 (1978)