The Impact of Pre-Operative Healthcare Utilization on Complications, Readmissions, and Post-Operative Healthcare Utilization Following Total Joint Arthroplasty.
The Impact of Pre-Operative Healthcare Utilization on Complications, Readmissions, and Post-Operative Healthcare Utilization Following Total Joint Arthroplasty.
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术前医疗保健利用对全关节置换术后并发症、再入院和术后医疗保健利用的影响。
DOI：
10.1016/j.arth.2021.11.018
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Edelstein AI
中科院分区：
文献类型：
--
作者：
Creager AE;Kleven AD;Kesimoglu ZN;Middleton AH;Holub MN;Bozdag S;Edelstein AI
确定全关节置换术(TJA)后不良结果和费用增加的危险因素是确保质量所必需的。术前卫生保健利用(Pre-HU)和TJA术后结果之间的相互作用尚未完全确定。这是一项回顾性队列研究，研究对象是2015-2019年在一家机构接受择期初次全髋关节置换(THA，N=1785)或全膝关节置换术(TKA，N=2159)的患者。HU前和术后卫生服务利用(Post-HU)分别包括TJA前、后90天的非选择性卫生服务利用(急诊科、急诊、观察入院、住院)。包括年龄、性别、ASA、医疗补助状况和BMI在内的多变量回归模型适用于30天再入院、CMS定义的并发症、住院时间和HU后。THA和TKA的30d再住院率分别为3.2%和3.4%，CMS定义并发症发生率分别为3.8%和2.9%。多因素回归分析显示，HU前与30天再入院风险增加(OR=2.85，95%CI1.48~5.50，p=0.002)、合并CMS并发症(OR=2.42，95%CI1.27~4.59，p=0.007)和HU后(OR=3.65，95%CI2.54~5.26，p<；0.001)相关。对于全膝关节置换术，≥-2在HU前事件与30天再入院(OR=3.52，95%CI1.17~10.61，P=0.026)和HU后(OR=2.64，95%CI1.29~5.40，P=0.008)的风险增加相关。THA(任何HU前)和TKA(≥2 Pre-HU)与住院时间和HU后事件次数呈正相关。在TJA前90天内使用非选择性医疗保健的患者，再入院、并发症和非计划的术后医疗保健利用的风险增加。第三级
Identifying risk factors for adverse outcomes and increased costs following total joint arthroplasty (TJA) is needed to ensure quality. The interaction between preoperative healthcare utilization (Pre-HU) and outcomes following TJA has not been fully characterized. This was a retrospective cohort study of patients undergoing elective, primary total hip (THA, N=1785) or total knee arthroplasty (TKA, N=2159) between 2015–2019 at a single institution. Pre-HU and postoperative healthcare utilization (Post-HU) included non-elective healthcare utilization in the 90 days prior to and following TJA, respectively (emergency department, urgent care, observation admission, inpatient admission). Multivariate regression models including age, sex, ASA, Medicaid status, and BMI were fit for 30-day readmission, CMS-defined complications, length of stay, and Post-HU. The 30-day readmission rate was 3.2% and 3.4% and the CMS-defined complication rate was 3.8% and 2.9% for THA and TKA, respectively. Multivariate regression showed for THA, presence of any Pre-HU was associated with increased risk of 30-day readmission (OR=2.85, 95% CI 1.48–5.50, p=0.002), CMS-complications (OR=2.42, 95% CI 1.27–4.59, p=0.007), and Post-HU (OR=3.65, 95% CI 2.54–5.26, p<0.001). For TKA, ≥ 2 Pre-HU events was associated with increased risk of 30-day readmission (OR=3.52, 95% CI 1.17–10.61, p=0.026) and Post-HU (OR=2.64, 95% CI 1.29–5.40, p=0.008). There were positive correlations for THA (any Pre-HU) and TKA (≥2 Pre-HU) with length of stay and number of Post-HU events. Patients that utilize non-elective healthcare in the 90 days prior to TJA are at increased risk of readmission, complications, and unplanned postoperative healthcare utilization. Level III
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影响因子：
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作者：
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