Trends in epidemiology of knee arthroplasty in the United States, 1990-2000
Trends in epidemiology of knee arthroplasty in the United States, 1990-2000
复制标题
DOI：
10.1002/art.21420
复制
发表时间：
2005-12-01
影响因子：
--
通讯作者：
Katz, JN
中科院分区：
文献类型：
--
作者：
Jain, NB;Higgins, LD;Katz, JN
客观的。关于全膝关节置换术（TKA）流行病学纵向趋势的信息很少。本研究旨在确定在过去十年中，年轻人和老年人的 TKA 率是否有所增加，少数族裔的 TKA 使用率是否有所增加，以及是否有更多的患者在大容量医院接受了手术。方法。 TKA 病例 (n = 443,008) 是从 1990-2000 年全国住院患者样本数据库中提取的。获得了 3 个时期的 TKA 趋势（1990-1993 年 [时期 I]、1994-1997 [时期 II] 和 1998-2000 [时期 III]）。 结果。在第一期和第三期之间，40-49岁年龄组进行全膝关节置换的比例增加了95.2%，50-59岁年龄组增加了53.7%。黑人患者和西班牙裔患者在 III 期比在 I 期更有可能接受 TKA（比值比 [OR] = 1.6，95% 置信区间 [95% CI] 1.5-1.6 和 OR 2.7，95% CI 2.5-2.9）。然而，白人患者在3个时间段的TKA中分别占93.0%、89.9%和87.5%。第三阶段，在大流量医院接受手术的患者比例较第一阶段和第二阶段有所增加。 III 期的死亡率和住院时间均显着缩短，但出院率增加了 89.7%（I 期至 III 期）。结论。在过去的十年中，全膝关节置换术越来越多地在年轻患者中进行，这表明该手术的适应症正在扩大。尽管全膝关节置换术在少数族裔中的使用有所增加，但绝大多数全膝关节置换术是在白人患者中进行的。需要进一步努力缩小这一差距。越来越多的大手术中心转向全膝关节置换手术可能会改善手术结果。最后，需要确定出院人数增加对全膝关节置换术结果的影响。
Objective. There is little information on longitudinal trends in the epidemiology of total knee arthroplasty (TKA). This study was undertaken to determine whether, during the past decade, TKA rates increased in younger adults and older adults, whether utilization of TKA increased among minorities, and whether more patients underwent surgery at high-volume hospitals.Methods. TKA cases (n = 443,008) were extracted from the 1990-2000 Nationwide Inpatient Sample database. TKA trends for 3 time periods were obtained (1990-1993 [period I], 1994-1997 [period II], and 1998-2000 [period III]).Results. Between period I and period III, the proportion of TKAs performed increased by 95.2% in the 40-49-year age group and by 53.7% in the 50-59-year age group. Black patients and Hispanic patients were more likely to undergo TKA in period III than in period I (odds ratio [OR] = 1.6, 95% confidence interval [95% CI] 1.5-1.6 and OR 2.7, 95% CI 2.5-2.9, respectively). However, white patients accounted for 93.0%, 89.9%, and 87.5% of TKAs in the 3 time periods, respectively. In period III, the proportion of patients undergoing surgery in high-volume hospitals increased compared with periods I and II. Both mortality and length of hospital stay diminished significantly in period III, but the rate of discharge to an inpatient facility increased by 89.7% (period I to period III).Conclusion. Over the past decade, TKA was increasingly performed in younger patients, which suggests a broadening of indications for this procedure. Although utilization of TKA increased among minorities, the vast majority of TKAs were performed in white patients. Further efforts to narrow this disparity are required. The shift toward TKAs being increasingly performed at high-volume centers may improve surgical outcomes. Finally, the effect of increased discharge to inpatient facilities on TKA outcomes needs to be ascertained.