Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008.
Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008.
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DOI：
10.1001/jama.2011.478
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发表时间：
2011-04-20
影响因子：
120.7
通讯作者：
Li, Yue
中科院分区：
文献类型：
--
作者：
Cram, Peter;Lu, Xin;Kaboli, Peter J.;Vaughan-Sarrazin, Mary S.;Cai, Xueya;Wolf, Brian R.;Li, Yue
全髋关节置换术（THA）是一种常见的外科手术，但对纵向趋势知之甚少。研究1991年至2008年间接受初次和翻修THA的患者的人口统计学和结局。观察性队列包括1，453，493名接受初次THA的Medicare受益人和348，596名接受翻修THA的患者。患者人口统计学和合并症的变化;住院时间（LOS）;死亡率;出院处置;和全因再入院率。1991年至2008年，初次THA的平均年龄从74.1岁（95% CI，74.0-74.1）增加到75.1岁（95% CI，75.1-75.2）（P=0.01），翻修THA的平均年龄从75.8岁（95% CI，75.7-75.9）增加到77.3岁（95% CI，77.2-77.4）（P<0.001）。初次THA患者的平均共病数从1.0（95%CI，1.0-1.0）增加到2.0（95%CI，2.0-2.0），翻修THA患者的平均共病数从1.1（95%CI，1.1-1.1）增加到2.3（95%CI，2.3-2.3）（两者P<0.001）。对于初次THA，LOS从9.1天减少到（95% CI，9.1-9.2）至3.7天（95%置信区间，3.7-3.7）（P=0.002）;未经调整的住院和30天死亡率从0.5%（95% CI，0.5%~ 0.5%）~ 0.2%（95% CI，0.2%~ 0.2%）（P< 0.001）和0.7%（95% CI，0.7%~ 0.7%）~ 0.4%（95% CI，0.4%~ 0.4%）（P< 0.001）。初次THA患者出院回家的比例从68.0%下降到68.0%，（95% CI，67.8%-68.3%）至48.2%（95% CI，48.0%-48.4%）（P<0.001）;出院后接受专业护理的比例从17.8%（95% CI，17.6%-18.1%）至34.3%（95% CI，34.1%-34.5%）（P<.001）; 30天全因再入院率从5.9%（95% CI，5.8%-6.1%）增加至8.5%（95% CI，8.4%-8.6%）（P<.001）。对于翻修THA，在医院LOS、住院死亡率、出院处置和再入院率方面观察到类似的趋势。在1991年至2008年期间接受初次和翻修髋关节置换术的医疗保险受益人中，医院LOS减少，但急性期后护理和再入院率增加。
Total hip arthroplasty (THA) is a common surgical procedure but little is known about longitudinal trends. To examine demographics and outcomes of patients undergoing primary and revision THA between 1991 and 2008. Observational cohort of 1,453,493 Medicare beneficiaries who underwent primary THA and 348,596 who underwent revision THA. Changes in patient demographics and comorbidity; hospital length of stay (LOS); mortality; discharge disposition; and all-cause readmission rates. Between 1991 and 2008 the mean age for primary THA increased from 74.1 (95% CI, 74.0-74.1) years to 75.1 (95% CI, 75.1-75.2)(P=0.01) and 75.8 (95% CI, 75.7-75.9) to 77.3 (95% CI, 77.2-77.4) for revision THA (P<.001). The mean number of comorbid illnesses per patient increased from 1.0 (95% CI, 1.0-1.0) to 2.0 (95% CI, 2.0-2.0) for primary and 1.1 (95% CI, 1.1-1.1) to 2.3 (95% CI, 2.3-2.3) for revision THA (P<.001 for both). For primary THA, LOS decreased from 9.1 days (95% CI, 9.1-9.2) in 1991–1992 to 3.7 days (95% CI, 3.7-3.7) in 2007–2008 (P=0.002); unadjusted in-hospital and 30-day mortality decreased from 0.5% (95% CI, 0.5%-0.5%) to 0.2% (95% CI, 0.2%-0.2%)(P< 0.001) and 0.7% (95% CI, 0.7%-0.7%) to 0.4% respectively (95% CI, 0.4%-0.4%)(P< 0.001). The proportion of primary THA patients discharged home declined from 68.0% (95% CI, 67.8%-68.3%) to 48.2% (95% CI, 48.0%-48.4%)(P<.001); the proportion discharged to skilled care increased from 17.8% (95% CI, 17.6%-18.1%) to 34.3% (95% CI, 34.1%-34.5%) (P<.001); 30-day all-cause readmission increased from 5.9% (95% CI, 5.8%-6.1%) to 8.5% (95% CI, 8.4%-8.6%) (P<.001). For revision THA similar trends were observed in hospital LOS, in-hospital mortality, discharge disposition, and hospital readmission rates. Among Medicare beneficiaries who underwent primary and revision hip arthroplasty between 1991 and 2008, there was a decrease in hospital LOS, but an increase in the rates of post-acute care and readmission.
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