Factors predicting complication rates following total knee replacement
Factors predicting complication rates following total knee replacement
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DOI：
10.2106/jbjs.e.00629
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发表时间：
2006-03-01
影响因子：
5.3
通讯作者：
Zingmond, DS
中科院分区：
文献类型：
--
作者：
SooHoo, NF;Lieberman, JR;Zingmond, DS
背景：本次调查的目的是通过更全面地研究各种患者和医院特征在确定全膝关节置换术后不良后果中的作用来扩展之前的研究。方法：利用 1991 年至 2001 年加利福尼亚州所有住院患者的数据，对全膝关节置换术患者的信息进行多元逻辑回归。出院后前九十天内因感染和肺栓塞导致的死亡率和再入院率根据各种自变量进行回归，包括人口因素（年龄、性别、种族、民族和保险类型）、共病负担（查尔森共病指数）和提供者变量（医院规模、教学状况和手术量）。然后进行单独的基线概率分析，以比较所有预测变量的相对重要性。结果：此分析的样本量为 222,684。出院后 90 天内，共有 1176 例死亡（死亡率为 0.53%）、1586 例感染（0.71%）和 914 例肺栓塞（0.41%）。手术时患者的平均年龄为六十九岁。 62% 的患者为女性，32% 的查尔森合并症指数 > 0。并发症的显着预测因素 (p < 0.05) 包括年龄、性别、种族/族裔、查尔森合并症指数、保险类型和医院数量。进行了基线概率分析，基本病例被认为是一名年龄超过 65 岁的白人女性，查尔森合并症指数为 0，拥有医疗保险，并在大容量非教学医院接受治疗。对于具有基线病例特征的患者，出院后前 90 天内死亡概率为 31/10,000，感染概率为 59/10,000，肺栓塞概率为 41/10,000。通过假设在低容量医院接受护理来改变基本情况，预期死亡率增加了 26%。将查尔森合并症指数提高到 1 会使死亡率增加 170%，而将年龄降低到 65 岁以下会使死亡率降低 73%。医院规模、合并症和年龄对因感染和肺栓塞导致的预期再入院率具有相似的影响。结论：年龄和查尔森合并症指数对全膝关节置换术后不良结果基线概率的影响与医院规模的影响相似或更大。这项研究阐明并比较了几种不同因素对结果影响的相对重要性。在考虑此类政策相关结果研究的结论和影响时，这些信息非常重要。
Background: The purpose of this investigation was to expand on previous studies by more fully examining the role of a variety of patient and hospital characteristics in determining adverse outcomes following total knee replacement.Methods: With use of data from all hospital admissions in California from 1991 through 2001, multiple logistic regression was performed on the information regarding patients treated with total knee replacement. Rates of mortality and readmission due to infection and pulmonary embolism during the first ninety days after discharge were regressed against a variety of independent variables, including demographic factors (age, gender, race, ethnicity, and insurance type), burden of comorbid disease (Charlson comorbidity index), and provider variables (hospital size, teaching status, and surgical volume). A separate baseline probability analysis was then performed to compare the relative importance of all predictor variables.Results: The sample size for this analysis was 222,684. A total of 1176 deaths (rate, 0.53%), 1586 infections (0.71%), and 914 pulmonary emboli (0.41%) occurred within the first ninety days after discharge. The average age of the patients at the time of surgery was sixty-nine years. Sixty-two percent of the patients were women, and 32% had a Charlson comorbidity index of > 0. The significant predictors for complications (p < 0.05) included age, gender, race/ethnicity, Charlson comorbidity index, insurance type, and hospital volume. A baseline probability analysis was performed with the base case considered to be a white woman who was over the age of sixty-five years, had a Charlson comorbidity index of 0, had Medicare insurance, and was treated at a high-volume, non-teaching hospital. For a patient with the baseline case characteristics, the probability of death was 31/10,000, the probability of infection was 59/10,000, and the probability of pulmonary embolism was 41/10,000 in the first ninety days after discharge. Altering the base case by assuming that care was received at a low-volume hospital increased the expected mortality rate by a factor of 26%. Increasing the Charlson comorbidity index to 1 increased the mortality rate by 170%, whereas decreasing the age to younger than sixty-five years lowered the mortality rate by 73%. Hospital volume, comorbidity, and age had similar effects on the expected rates of readmission due to infection and pulmonary embolism.Conclusions: The effects of age and the Charlson comorbidity index on the baseline probability of adverse outcomes following total knee replacement were shown to be similar to or greater than the effect of hospital volume. This study elucidates and compares the relative importance of the effects of several different factors on outcome. This information is important when considering the conclusions and implications of this type of policy-relevant outcomes research.