The Epidemiology of Revision Total Hip Arthroplasty in the United States
The Epidemiology of Revision Total Hip Arthroplasty in the United States
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DOI：
10.2106/jbjs.h.00155
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发表时间：
2009-01-01
影响因子：
5.3
通讯作者：
Berry, Daniel J.
中科院分区：
文献类型：
--
作者：
Bozic, Kevin J.;Kurtz, Steven M.;Berry, Daniel J.
背景资料：了解失败的原因和翻修全髋关节置换术的类型对于指导研究、植入物设计、临床决策和医疗保健政策至关重要。本研究的目的是评价在美国使用新实施的ICD-9-CM进行的全髋关节置换翻修手术的失败机制和类型（国际疾病分类，第九次修订，临床修改）诊断和程序代码，特别是与翻修全髋关节置换术在一个大的，全国代表性的人口。使用医疗保健成本和利用项目全国住院患者样本数据库分析了2005年10月1日至2006年12月31日期间进行的51，345例全髋关节置换术翻修手术的临床、人口统计学和经济学数据。根据年龄、性别、诊断、人口普查地区、主要支付者类别和医院类型分层，计算美国人群亚组的翻修手术患病率。失败的原因，平均住院时间，和总费用也确定为每种类型的翻修programmes.Results：最常见的类型的翻修全髋关节置换术进行的是全部件翻修（41.1%），最常见的原因是不稳定/脱位（22.5%），机械松动（19.7%），和感染（14.8%）。翻修全髋关节置换术最常在大型、城市、非教学医院进行，患者年龄在75 ~ 84岁之间。所有类型的翻修关节成形术的平均住院时间为6.2天，平均总费用为54，553美元。然而，平均住院时间，平均收费，和程序频率变化很大，根据人口普查地区，医院类型，和类型的翻修全髋关节置换术procedure.Conclusions：髋关节不稳定和机械松动是最常见的适应症，在美国的翻修全髋关节置换术。随着新的诊断和手术代码与翻修全髋关节置换术相关的进一步经验的获得，这些信息将在指导未来的研究、植入物设计和临床决策方面具有价值。
Background: Understanding the causes of failure and the types of revision total hip arthroplasty performed is essential for guiding research, implant design, clinical decision-making, and health-care policy. The purpose of the present study was to evaluate the mechanisms of failure and the types of revision total hip arthroplasty procedures performed in the United States with use of newly implemented ICD-9-CM (international Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis and procedure codes related specifically to revision total hip arthroplasty in a large, nationally representative population.Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze clinical, demographic, and economic data from 51,345 revision total hip arthroplasty procedures performed between October 1, 2005, and December 31, 2006. The prevalence of revision procedures was calculated for population subgroups in the United States that were stratified according to age, sex, diagnosis, census region, primary payer class, and type of hospital. The cause of failure, the average length of stay, and total charges were also determined for each type of revision arthroplasty procedure.Results: The most common type of revision total hip arthroplasty procedure performed was all-component revision (41.1%), and the most common causes of revision were instability/dislocation (22.5%), mechanical loosening (19.7%), and infection (14.8%). Revision total hip arthroplasty procedures were most commonly performed in large, urban, nonteaching hospitals for Medicare patients seventy-five to eighty-four years of age. The average length of hospital stay for all types of revision arthroplasties was 6.2 days, and the average total charges were $54,553. However, the average length of stay, average charges, and procedure frequencies varied considerably according to census region, hospital type, and type of revision total hip arthroplasty procedure performed.Conclusions: Hip instability and mechanical loosening are the most common indications for revision total hip arthroplasty in the United States. As further experience is gained with the new diagnosis and procedure codes specifically related to revision total hip arthroplasty, this information will be valuable in directing future research, implant design, and clinical decision-making.