Veterans Undergoing Total Hip and Knee Arthroplasty: 30-day Outcomes as Compared to the General Population
Veterans Undergoing Total Hip and Knee Arthroplasty: 30-day Outcomes as Compared to the General Population
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DOI：
10.5435/jaaos-d-19-00775
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发表时间：
2020-11-15
影响因子：
3.2
通讯作者：
Gerlinger, Tad L.
中科院分区：
文献类型：
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作者：
Frisch, Nicholas B.;Courtney, P. Maxwell;Gerlinger, Tad L.
导言：退伍军人事务部(VA)卫生系统对于为我们的退役军人提供关节替代护理至关重要，但最近受到了审查。本研究的目的是比较退伍军人事务部队列和普通队列的全髋关节置换术(THA)和全膝关节置换术(TKA)的短期疗效。方法：我们回顾了来自退伍军人事务公司数据仓库的10.460例原发THA和TKA患者。作为对照组，我们查询了美国外科医生学会-国家外科质量改进计划数据库，确定了58,820名在同一时间段内患有原发THA和TKA的患者。我们比较了住院时间、死亡率、30天并发症发生率和30天再住院时间。我们进行了多元Logistic回归分析，以确定退伍军人系统对不良结果的独立影响。结果：退伍军人更有可能是男性(93%对41%，P<；0.001)，并增加了医疗合并症的发生率(均P<；0.001)。在VA队列中，短期并发症的发生率(均为P<；0.001)都较高。在控制人口统计学和医疗并发症时，VA患者更有可能再次入院(P<；0.001)，住院时间延长4天(P<；0.001)，并在30天内出现并发症(P<；0.001)。讨论：尽管控制了较高的医疗并发症发生率，但接受初次全髋关节置换术和全膝关节置换术的VA患者的短期结果比普通人群差。需要进行更多的研究，以确保我们的退伍军人群体得到适当的优化，并解决与平民结果的差异。
Introduction: The Veterans Affairs (VA) health system is vital to providing joint replacement care to our retired service members but has come under recent scrutiny. The purpose of this study was to compare the short-term outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA) between the VA cohort and the general cohort.Methods: We retrospectively reviewed 10.460 patients with primary THA and TKA from the Veterans Affairs Corporate Data Warehouse. As a control group, we queried the American College of Surgeons-National Surgical Quality Improvement Program database and identified 58,820 patients with primary THA and TKA over the same time period. We compared length of stay, mortality rates, 30-day complication rates, and 30-day readmissions. We performed a multivariate logistic regression analysis to identify the independent effect of the VA system on adverse outcomes.Results: Veterans are more likely to be men (93% versus 41%, P < 0.001) and have increased rates of medical comorbidities (all P < 0.001). The rate of short-term complications (all P < 0.001) were all higher in the VA cohort. When controlling for demographics and medical comorbidities, VA patients were more likely to have a readmission (P < 0.001), prolonged length of stay > 4 days (P < 0.001), and experience a complication within 30 days (P < 0.001).Discussion: Despite controlling for higher rates of medical comorbidities, VA patients undergoing primary THA and TKA had poorer short-term outcomes than the civilian cohort. Additional research is needed to ensure our veteran cohort is appropriately optimized and address the discrepancy with the outcomes of the civilian.