| Objective:Analysizing retrospectively recorded perioperative data of patients undergoing hip arthroplasty during the past 6 years in Southern Hospital of Southern Medical University to investigate the incidence and risk factors for gastrointestinal complications after hip arthroplasty.Methods:1.Inclusion standards:This study selected perioperative data of patients undergoing hip arthroplasty in Southern Hospital of Southern Medical University from Jan,2012 to Dec,2017,and inclusion standards were:(1)no undergoing of other surgical operation or intervention before hip arthroplasty during hospital stay;(2)no acute gastrointestinal complications in patients before hip arthroplasty hospital stay.2.Definition for gastrointestinal complications:This study included negative postoperative gastrointestinal events after hip arthroplasty.According to the contracted Accordion severity classification of postoperative complications,they were graded into mild and moderate to severe.The mild ones included nausea(case record),vomit(case record),abdominal distension(case record),constipation(the first stool pass after hip arthroplasty showed>3 days after oral resumption),and diarrhea(stool pass>3 times/day after oral resumption),and the moderate to severe ones included intestinal obstruction(symptoms and typical iconography X-ray findings),ulcer(proved by alimentary tract contrast or endoscope),gastrointestinal bleeding(haematemesis and/or melena or diagnosed by endoscope)and perforation(X-ray findings and typical symptoms).3.Statistical variable:Our study recorded perioperative variables of patients undergoing hip arthroplasty during hospital stay.Results:956 patients undergoing hip arthroplasty were included in this study,with average age of(56.1±15.5)years and age range of 17?97 years,including 466 male patients and 490 female patients.164 patients in total(17.2%)had gastrointestinal complications and most of them(162/164)showed mild gastrointestinal complications including nausea7.3%(70/956),vomiting6.4%(61/956),abdominal distension1.7%(16/956),constipation8.4%(80/956),diarrheal.3%(12/956).Moderate to severe gastrointestinal complications included 1 case of intestinal obstruction and 1 case of stress gastric ulcer.Univariate analysis results showed that there was a significant difference in some of these variables between group with and without gastrointestinal complications,including age(P=0.015),gender(P<0.001),hypertension(P=0.002),aspartate aminotransferase(P=0.047),serum albumin(P=0.022),anesthesia type(P=0.001),operation duration(P<0.001),anesthesia duration(P<0.001),fluid infusion(P=0.009),urine output(P=0.025),hospital stay(P=0.001),postoperative hospital stay(P<0.001).Multivariate logistic regression analysis showed that female(OR=1.991,P<0.001),hypertension(OR=1.594,P=0.028),general anesthesia(OR=1.711,P=0.005)and operation duration(OR=1.006,P=0.012)were the independent risk factors for gastrointestinal complications after hip arthroplasty.Propensity score matching analysis results showed that patients in general anesthesia group had more fluid infusion(P<0.001),longer duration of anesthesia(P<0.001),and a higher incidence of gastrointestinal complications(P=0.031).Conclusion:The incidence of postoperative gastrointestinal complications in patients undergoing hip arthroplasty is comparatively high.More attention is needed for female patients in case of gastrointestinal complications.Maintaining stable perioperative blood pressure for patients with hypertension,choosing general anesthesia cautiously,and shortening operation duration rationally are important measures to reduce postoperative gastrointestinal complications.Propensity score matching analysis showed that intraspinal anesthesia can reduce the incidence of gastrointestinal complications and is superior to general anesthesia. |
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