Epidemiology of total knee replacement in the United States Medicare population
Epidemiology of total knee replacement in the United States Medicare population
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DOI：
10.2106/jbjs.d.02546
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发表时间：
2005-06-01
影响因子：
5.3
通讯作者：
Losina, E
中科院分区：
文献类型：
--
作者：
Mahomed, NN;Barrett, J;Losina, E
背景：关于全膝关节置换术的利用和结果的基于人群的数据有限。本研究的目的是描述美国 65 岁以上人群的初次和翻修全膝关节置换率以及选定的结局。方法：利用 Medicare 索赔，我们计算了 2000 年美国 Medicare 受益人中单侧选择性初次和翻修全膝关节置换术的年发生率。泊松回归用于评估人口特征与初次和翻修膝关节置换术发生率之间的关系。使用比例风险模型来检查 90 天并发症发生率与人口和临床因素之间的关系。结果：黑人的初次膝关节置换率低于白人，符合医疗补助补充资格的人低于收入较高的人。初次膝关节置换术后 90 天内观察到的并发症包括死亡率（0.7%）、再入院（0.9%）、肺栓塞（0.8%）、伤口感染（0.4%）、肺炎（1.4%）和心肌梗死（0.8%）。膝关节翻修术后 90 天内观察到的并发症包括死亡率（1.1%）、再入院（4.7%）、肺栓塞（0.5%）、伤口感染（1.8%）、肺炎（1.4%）和心肌梗死（1.0%）。初次膝关节置换术后黑人的死亡率、再入院率和伤口感染率高于白人。符合医疗补助补充资格的患者并发症发生率较高，尤其是初次膝关节置换术后。结论：总体而言，全膝关节置换术后 90 天内的术后并发症发生率较低。在美国，黑人和低收入人群接受全膝关节置换术的频率较低，并且初次膝关节置换术后不良后果的发生率通常较高。证据级别：预后 II 级。有关证据级别的完整描述，请参阅作者须知。
Background: There are limited population-based data on the utilization and outcomes of total knee replacement. The aim of the present study was to describe the rates of primary and revision total knee replacement and selected outcomes in persons older than sixty-five years of age in the United States.Methods: Using Medicare claims, we computed annual incidence rates of unilateral elective primary and revision total knee replacement among United States Medicare beneficiaries in the year 2000. Poisson regression was used to assess the relationships between demographic characteristics and the incidence rates of primary and revision knee replacement. Proportional hazards models were used to examine the relationships between the ninety-day rates of complications and demographic and clinical factors.Results: The rate of primary knee replacement was lower in blacks than in whites and in those qualifying for Medicaid supplementation than in those with higher incomes. The complications observed during the ninety days following primary knee replacement included mortality (0.7%), readmission (0.9%), pulmonary embolus (0.8%), wound infection (0.4%), pneumonia (1.4%), and myocardial infarction (0.8%). The complications observed during the ninety days following revision knee replacement were mortality (1.1%), readmission (4.7%), pulmonary embolus (0.5%), wound infection (1.8%), pneumonia (1.4%), and myocardial infarction (1.0%). Blacks had higher rates of mortality, readmission, and wound infection after primary knee replacement than whites did. Patients who qualified for Medicaid supplementation had higher complication rates, particularly after primary knee replacement.Conclusions: Overall, the rates of postoperative complications during the ninety days following total knee replacement are low. In the United States, blacks and individuals with low income undergo total knee replacement less frequently and generally have higher rates of adverse outcomes following primary knee replacement.Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.