Vincent Kevin R, Vincent Heather K, Lee Laura W, Alfano Alan P
Department of Physical Medicine and Rehabilitation, The University of Virginia Health System, Charlottesville, VA 22908, USA.
Am J Phys Med Rehabil. 2006 Jun;85(6):482-9. doi: 10.1097/01.phm.0000219151.18749.50.
To examine age and gender effects on outcomes after inpatient rehabilitation in primary total knee arthroplasty (TKA) and revision TKA patients.
This retrospective, comparative study was conducted in a 50-bed, university-affiliated rehabilitation hospital. Patients included primary TKA patients (n = 286) and revision TKA patients (n = 138) placed into one of three age brackets: <60 yrs, 60-70 yrs, or >70 yrs. Measurements included length of stay (LOS), FIM scores, hospital charges, and discharge disposition location.
FIM scores improved from admission to discharge in both primary and revision patients (P = 0.015). LOS was shorter in primary than revision patients (8.3 vs. 10.4 days, P = 0.001), and the LOS was longest in patients >70 yrs compared with those <60 or 60-70 yrs (10.6 vs. 8.7 and 8.8 days, respectively; P = 0.004). FIM efficiency was greater in primary than in revision TKA patients (3.68 vs. 2.77 points/day, P = 0.001), and greater for men than women in each age bracket regardless of TKA type (3.68 vs. 2.78 points/day, P = 0.001). Total hospital charges were lower for men than women for both TKA types ($9,656 +/- 823 vs. $11,544 +/- 1,359; P = 0.015), and were highest in patients >70 yrs of age (P = 0.015).
Primary and revision TKA patients make improvements in functional independence during inpatient rehabilitation. Although FIM gains were similar among age and gender groupings, FIM efficiency is lowest in women. Despite similar daily hospital costs among the groups, slower progress with functional gains (decreased FIM efficiency) increases the LOS and total hospital charges, especially in older women.
研究初次全膝关节置换术（TKA）和TKA翻修术患者住院康复后的年龄和性别对康复结局的影响。
本回顾性比较研究在一家拥有50张床位的大学附属医院康复医院进行。患者包括初次TKA患者（n = 286）和TKA翻修术患者（n = 138），分为三个年龄组之一：<60岁、60 - 70岁或>70岁。测量指标包括住院时间（LOS）、FIM评分、医院费用和出院安置地点。
初次和翻修患者从入院到出院FIM评分均有所改善（P = 0.015）。初次手术患者的LOS短于翻修患者（8.3天对10.4天，P = 0.001），>70岁患者的LOS最长，与<60岁或60 - 70岁患者相比（分别为10.6天对8.7天和8.8天；P = 0.004）。初次TKA患者的FIM效率高于翻修TKA患者（3.68分/天对2.77分/天，P = 0.001），且在每个年龄组中，无论TKA类型如何，男性的FIM效率均高于女性（3.68分/天对2.78分/天，P = 0.001）。两种TKA类型中，男性的总住院费用均低于女性（9,656 ± 823美元对11,544 ± 1,359美元；P = 0.015），且在>70岁患者中最高（P = 0.015）。
初次和翻修TKA患者在住院康复期间功能独立性得到改善。尽管年龄和性别分组之间FIM得分的增加相似，但女性的FIM效率最低。尽管各组之间每日医院费用相似，但功能改善进展较慢（FIM效率降低）会增加LOS和总住院费用，尤其是老年女性。
