Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA
Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA
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DOI：
10.1007/s11999-014-4078-8
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发表时间：
2015-06-01
影响因子：
4.2
通讯作者：
Berry, Daniel J.
中科院分区：
文献类型：
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作者：
Bozic, Kevin J.;Kamath, Atul F.;Berry, Daniel J.
翻修THA和TKA是日益增长的重要临床和经济挑战。医疗保健系统倾向于将联合收割机翻修关节置换手术合并到单一服务线中，翻修THA和翻修TKA之间的差异仍不完全。这些差异对指导护理和资源分配产生了影响。因此，我们评估了与翻修THA和TKA相关的流行病学趋势，我们试图确定以下方面的差异：（1）接受翻修TKA和THA的患者数量和各自的人口统计学趋势;（2）翻修TKA和THA的适应症和类型的差异;（3）THA和TKA患者疾病严重程度评分的差异;（4）资源利用差异在2005年10月1日至12月31日期间，使用全国住院患者样本（NIS）评价了235，857例翻修THA和301，718例翻修TKA，2010.比较了翻修THA和TKA的患者特征、手术信息和资源利用。计算髋关节和膝关节手术的翻修负担（翻修数量与翻修和初次手术总数的比值）。疾病严重程度评分和成本计算来自NIS。由于我们的研究主要是描述性的，通常不进行统计分析;然而，由于通过NIS分析我们可以获得的样本量很大，即使观察到的微小差异也可能具有高度的统计学显著性。翻修型TKA增加了39%（翻修负担，9.1%-9.6%），THA增加了23%（翻修负担，15.4%-14.6%）。与翻修TKA相比，翻修THA更常在老年患者中进行。假体周围关节感染（25%）和机械性松动（19%）是TKA翻修的最常见原因，而THA翻修的最常见原因是脱位（22%）和机械性松动（20%）。全（全部件）翻修在翻修THA（43%）中比在TKA（37%）中更常见。接受翻修THA的患者通常比接受翻修TKA的患者（65%中度疾病严重程度评分）病情更重（> 50%严重疾病严重程度评分）。翻修THA的平均LOS长于TKA。翻修THA的平均住院费用（24，697美元+/-40，489美元[标准差]）略高于翻修TKA（23，130美元+/-36，643美元[标准差]）。假体周围关节感染和假体周围骨折与翻修THA和TKAs的最大LOS和成本相关，这些数据对于医疗保健系统合理分配髋关节和膝关节手术资源非常重要：THA的翻修负担比TKA高52%，但翻修TKA的增长速度更快。同样，治疗临床医生应了解，虽然翻修THA和TKA都承担了显著的临床和经济成本，但接受翻修THA的患者往往年龄较大，病情较重，护理成本较高。
Revision THA and TKA are growing and important clinical and economic challenges. Healthcare systems tend to combine revision joint replacement procedures into a single service line, and differences between revision THA and revision TKA remain incompletely characterized. These differences carry implications for guiding care and resource allocation. We therefore evaluated epidemiologic trends associated with revision THAs and TKAs.We sought to determine differences in (1) the number of patients undergoing revision TKA and THA and respective demographic trends; (2) differences in the indications for and types of revision TKA and THA; (3) differences in patient severity of illness scoring between THA and TKA; and (4) differences in resource utilization (including cost and length of stay [LOS]) between revision THA and TKA.The Nationwide Inpatient Sample (NIS) was used to evaluate 235,857 revision THAs and 301,718 revision TKAs between October 1, 2005 and December 31, 2010. Patient characteristics, procedure information, and resource utilization were compared across revision THAs and TKAs. A revision burden (ratio of number of revisions to total number of revision and primary surgeries) was calculated for hip and knee procedures. Severity of illness scoring and cost calculations were derived from the NIS. As our study was principally descriptive, statistical analyses generally were not performed; however, owing to the large sample size available to us through this NIS analysis, even small observed differences presented are likely to be highly statistically significant.Revision TKAs increased by 39% (revision burden, 9.1%-9.6%) and THAs increased by 23% (revision burden, 15.4%-14.6%). Revision THAs were performed more often in older patients compared with revision TKAs. Periprosthetic joint infection (25%) and mechanical loosening (19%) were the most common reasons for revision TKA compared with dislocation (22%) and mechanical loosening (20%) for revision THA. Full (all-component) revision was more common in revision THAs (43%) than in TKAs (37%). Patients who underwent revision THA generally were sicker (> 50% major severity of illness score) than patients who underwent revision TKA (65% moderate severity of illness score). Mean LOS was longer for revision THAs than for TKAs. Mean hospitalization costs were slightly higher for revision THA (USD 24,697 +/- USD 40,489 [SD]) than revision TKA (USD 23,130 +/- USD 36,643 [SD]). Periprosthetic joint infection and periprosthetic fracture were associated with the greatest LOS and costs for revision THAs and TKAs.These data could prove important for healthcare systems to appropriately allocate resources to hip and knee procedures: the revision burden for THA is 52% greater than for TKA, but revision TKAs are increasing at a faster rate. Likewise, the treating clinician should understand that while both revision THAs and TKAs bear significant clinical and economic costs, patients undergoing revision THA tend to be older, sicker, and have greater costs of care.