Rates and outcomes of primary and revision total hip replacement in the United States Medicare population
Rates and outcomes of primary and revision total hip replacement in the United States Medicare population
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DOI：
10.2106/00004623-200301000-00005
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发表时间：
2003-01-01
影响因子：
5.3
通讯作者：
Baron, JA
中科院分区：
文献类型：
--
作者：
Mahomed, NN;Barrett, JA;Baron, JA
工作背景：关于初次全髋关节置换术的流行病学信息有限，我们不知道任何关于全髋关节置换术翻修的流行病学报告。本研究的目的是描述居住在美国的65岁及以上人群初次和翻修全髋关节置换术的发生率和术后即刻结局。方法：我们使用了1995年7月1日至1996年6月30日期间医院、医生和门诊设施提交的医疗保险索赔，识别因骨折以外的原因接受择期初次全髋关节置换术（61，568例患者）或接受翻修全髋关节置换术（13，483例患者）的个体。计算初次和翻修全髋关节置换术的年发病率，并使用多变量模型评估患者特征与手术率之间的相关性。术后90天内的五个并发症的发生率也进行了评估，这些结果和患者特征之间的关系进行了评估与使用多变量模型调整医院和外科医生volume.Results：初次全髋关节置换术的发病率是三至六倍高于翻修全髋关节置换术的发病率。妇女的发病率高于男子，白人的发病率高于黑人。初次和翻修全髋关节置换率随着年龄的增长而增加，直到75岁到79岁，然后下降。初次全髋关节置换术后90天内的并发症发生率为死亡率1.0%，肺栓塞0.9%，伤口感染0.2%，再次住院4.6%，髋关节脱位3.1%。全髋关节置换术后翻修率分别为2.6%、0.8%、0.95%、10.0%和8.4%。与不良结果风险增加相关的因素包括年龄、性别增加（男性的风险高于女性），种族（黑人比白人的风险高），医疗合并症，和低收入。结论：对美国医疗保险人口数据的分析表明，全髋关节置换率随着年龄的增长而增加，直到75岁到70岁，9年，黑人的全髋关节置换率明显低于白人。不良结局的总体发生率相对较低，但翻修后明显高于初次全髋关节置换术后。证据等级：预后研究，II-1级（回顾性研究）。证据等级的完整描述见第2页。
Background: Information on the epidemiology of primary total hip replacement is limited, and we are not aware of any reports on the epidemiology of revision total hip replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total hip replacement in persons sixty-five years of age and older residing in the United States.Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total hip replacement for a reason other than a fracture (61,568 patients) or had had revision total hip replacement (13,483 patients). Annual incidence rates of primary and revision total hip replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationships between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume.Results: The rates of primary total hip replacement were three to six times higher than the rates of revision total hip replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total hip replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total hip replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for hip dislocation. The rates after revision total hip replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income.Conclusions: Analysis of United States Medicare population data showed that the rates of total hip replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total hip replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total hip replacement.Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.