Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010.
Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010.
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DOI：
10.1001/2012.jama.11153
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发表时间：
2012-09-26
影响因子：
120.7
通讯作者：
Wolf, Brian R.
中科院分区：
文献类型：
--
作者：
Cram, Peter;Lu, Xin;Kates, Stephen L.;Singh, Jasvinder A.;Li, Yue;Wolf, Brian R.
全膝关节置换术(TKA)是美国最常见和最昂贵的外科手术之一。检查1991至2010年间美国联邦医疗保险人群中初次和修订TKA的数量、利用率和结果的纵向趋势。观察队列中有3,271,851名患者接受了初次TKA，318,563名患者接受了Medicare A部分数据文件中确定的翻修TKA。我们检查了初始和修订的全膝关节置换量、人均利用率、住院时间(LOS)、再住院率和不良结果的变化。1991年至2010年间，TKA年初级使用量从93,230个增加到226,177个，增幅为161.5%，而人均使用量增长了99.2%。修订后的TKA数量从9,650个增加到19,871个，增加了105.9%，利用率增加了56.8%。对于原发性全膝关节置换术，LOS从1991年-1994年的7.9d(95%可信区间，7.8-7.9d)减少到2007年-2010年的3.5d(95%可信区间，3.5%-3.5d)(P<；0.001)。在1991年至2010年期间，初次全膝关节置换术不良结果发生率保持稳定，但全原因30天再住院率从4.2%(95%可信区间4.1-4.2)上升至5.0%(95%可信区间4.9-5.0)(P<；0.001)。对于修订的TKA，伴随着住院LOS的下降伴随着30天再住院率从6.1%(95%CI，5.9-6.4)增加到8.9%(95%CI，8.7-9.2)(P<；.001)，伤口感染率从1.4%(95%CI，1.3-1.5)增加到3.0%(95%CI，2.9-3.1)(P<；.001)。TKA数量的增加在很大程度上是由人均使用量的增加推动的。我们还观察到伴随着住院再住院率上升的医院损失率的下降。
Total Knee Arthroplasty (TKA) is one of the most common and costly surgical procedures performed in the United States (U.S.). To examine longitudinal trends in volume, utilization and outcomes for primary and revision TKA between 1991 and 2010 in the U.S. Medicare population. Observational cohort of 3,271,851 patients who underwent primary TKA and 318,563 who underwent revision TKA identified in Medicare Part A data files. We examined changes in primary and revision TKA volume, per-capita utilization, hospital length of stay (LOS), readmission rates, and adverse outcomes. Between 1991 and 2010 annual primary TKA volume increased 161.5% from 93,230 to 226,177 while per-capita utilization increased 99.2%. Revision TKA volume increased 105.9% from 9,650 to 19,871 while utilization increased 56.8%. For primary TKA, LOS decreased from 7.9 days (95% CI, 7.8–7.9) in 1991–1994 to 3.5 days (95% CI, 3.5-3.5) in 2007–2010 (P< 0.001). For primary TKA rates of adverse outcomes resulting in readmission remained stable between 1991–2010, but rates of all-cause 30-day readmission increased from 4.2% (95% CI, 4.1–4.2) to 5.0% (95% CI, 4.9–5.0) (P<0.001). For revision TKA, the decline in hospital LOS was accompanied by an increase in 30-day readmission from 6.1% (95% CI, 5.9–6.4) to 8.9% (95% CI, 8.7–9.2) (P<.001) and an increase in wound infection rates from 1.4% (95% CI, 1.3–1.5) to 3.0% (95% CI, 2.9–3.1) (P<.001). Increases in TKA volume have largely been driven by increases in per-capita utilization. We also observed decreases in hospital LOS that were accompanied by increases in hospital readmission rates.
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影响因子：
120.7
作者：
Cram, Peter;Lu, Xin;Kaboli, Peter J.;Vaughan-Sarrazin, Mary S.;Cai, Xueya;Wolf, Brian R.;Li, Yue
通讯作者：
Li, Yue
影响因子：
5.3
作者：
Cram, Peter;Vaughan-Sarrazin, Mary S.;Rosenthal, Gary E.
通讯作者：
Rosenthal, Gary E.
DOI：
10.1111/j.1365-2753.2006.00733.x
发表时间：
2007-06-01
影响因子：
2.4
作者：
Escobar, Antonio;Quintana, Jose M.;Vidaurreta, Ignacio
通讯作者：
Vidaurreta, Ignacio
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
158.5
作者：
Chan, L;Koepsell, TD;Stolov, WC
通讯作者：
Stolov, WC