Clinical Outcomes and Costs Within 90 Days of Primary or Revision Total Joint Arthroplasty
Clinical Outcomes and Costs Within 90 Days of Primary or Revision Total Joint Arthroplasty
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DOI：
10.1016/j.arth.2016.01.022
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发表时间：
2016-07-01
影响因子：
3.5
通讯作者：
Vose, Joshua G.
中科院分区：
文献类型：
--
作者：
Nichols, Christine I.;Vose, Joshua G.
背景资料：本研究评估了与出院目的地和再入院相关的因素和成本，手术后90天内，初次或翻修全膝关节置换术（TKA）和全髋关节置换术（THA）。方法：本回顾性数据库分析使用了Truven MarketScan数据库（2009-2013）的医疗保健索赔。选择年龄≥ 18岁的患者，从3个月基线至3个月随访期间连续纳入健康计划。采用Logistic回归和考克斯比例风险模型分析与出院目的地和再入院风险相关的因素。根据并发症、出院目的地和再入院状态计算不同患者护理途径的90天总成本。结果：共有323，803例初次TKA、25，354例翻修TKA、159，390例初次THA和17，934例翻修THA病例符合选择标准。每个队列的全因并发症发生率分别为2.5%、37.2%、2.6%和35.0%。并发症、输血和住院时间>= 3天与出院回家接受家庭健康服务或熟练护理机构（SNF）的几率比在自我护理下回家的几率更大相关（所有队列P < .001），而出院回家接受家庭健康服务或SNF与再入院的风险更大相关（除一个队列外，所有队列P < .05）。最高（翻修、SNF、再入院）与最低成本（初级、家庭自理、无再入院）护理路径的90天总成本之比为1.8 - 2.2。结论：随着全关节置换术的医疗保险支付政策向捆绑支付转变，必须认识到与离群成本相关的因素，以保持盈利。(C)2016作者爱思唯尔公司出版这是一个在CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
Background: This study evaluated the factors and costs associated with discharge destination and readmission, within 90 days of surgery, for primary or revision total knee arthroplasty (TKA) and total hip arthroplasty (THA).Methods: This retrospective database analysis used health care claims from the Truven MarketScan Database (2009-2013). Patients were selected if aged >= 18 years, with continuous health plan enrollment from 3-month baseline through 3-month follow-up. Logistic regression and Cox proportional hazard models were used to analyze factors associated with discharge destination and risk of readmission. Total 90-day costs were calculated for different patient pathways of care, dependent on complications, discharge destination, and readmission status.Results: A total of 323,803 primary TKA, 25,354 revision TKA, 159,390 primary THA, and 17,934 revision THA cases met selection criteria. All-cause complications occurred in 2.5%, 37.2%, 2.6%, and 35.0% of each cohort. Complications, transfusions, and length of stay >= 3 days were associated with greater odds of discharge to home with home health services or skilled nursing facility (SNF) vs home under self-care (P < .001 all cohorts), whereas discharge to home with home health services or SNF was associated with greater risk of readmission (P < .05 for all cohorts except one). The ratio of total 90-day costs for the highest- (revision, SNF, readmission) vs lowest-cost (primary, home under self-care, no readmission) care pathways ranged from 1.8 to 2.2.Conclusion: As Medicare payment policy for total joint arthroplasty shifts toward bundling, an awareness of factors associated with outlier costs will be requisite to remain profitable. (C) 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).