Feinglass Joe, Koo Samuel, Koh Jason
Division of General Internal Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
Clin Orthop Relat Res. 2004 Dec(429):279-85. doi: 10.1097/01.blo.0000137563.27841.e9.
A paucity of population-based data exist which describe the rapid growth of revision total knee arthroplasties, changes in patient characteristics, or the association of hospital volume with complication rates. We analyzed whether inpatient complications for 2986 revision knee arthroplasties done on patients admitted to 63 hospitals in northern Illinois from 1993-1999 were correlated with volume of revision total knee arthroplasties. Coded complication rates for hospitals with less than seven, seven to 14, or greater than 14 annual procedures were compared using logistic regression to control for clinical and demographic characteristics of patients, hospital teaching status, and the proportion of the hospitals' patients discharged to rehabilitation facilities. Revision total knee arthroplasties increased 59%, and the overall complication rate declined from 9.3% during 1993-1996 to 7.3% during 1997-1999 (p = .04). When compared with the lowest volume hospitals, medium-volume hospitals had higher complication rates, whereas the highest volume hospitals were not significantly different. The absence of volume-outcome effects may be related to the relatively high volume of primary knee arthroplasties done at almost all area hospitals, surgeon group coverage across multiple hospitals, and the small annual number of revision total knee arthroplasties done during these years.
目前缺乏基于人群的数据来描述翻修全膝关节置换术的快速增长、患者特征的变化，或医院手术量与并发症发生率之间的关联。我们分析了1993年至1999年在伊利诺伊州北部63家医院住院的患者接受的2986例膝关节翻修术的住院并发症是否与翻修全膝关节置换术的手术量相关。使用逻辑回归比较了年手术量少于7例、7至14例或多于14例的医院的并发症编码率，以控制患者的临床和人口统计学特征、医院教学状况以及出院到康复机构的患者比例。翻修全膝关节置换术增加了59%，总体并发症发生率从1993年至1996年的9.3%降至1997年至1999年的7.3%（p = 0.04）。与手术量最低的医院相比，中等手术量的医院并发症发生率更高，而手术量最高的医院则无显著差异。手术量与结果之间缺乏关联可能与几乎所有地区医院的初次膝关节置换术手术量相对较高、外科医生团队覆盖多家医院以及这些年翻修全膝关节置换术的年手术量较少有关。
