Vincent Kevin R, Lee Laura W, Weng Jenpin, Alfano Alan P, Vincent Heather K
Department of Physical Medicine and Rehabilitation, University of Virginia Health System, Charlottesville, Virginia 22908-1004, USA.
Am J Phys Med Rehabil. 2006 Nov;85(11):872-81. doi: 10.1097/01.phm.0000242647.81882.5c.
To analyze inpatient rehabilitation outcomes in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA) patients using the 2004 Medicare 75% rule criteria.
This retrospective study compared outcomes in unilateral TKA (UTKA), bilateral TKA (BTKA), and THA after interdisciplinary inpatient rehabilitation (n = 867). Patients were separated into three comparison pairs: 1) UTKA or BTKA, 2) age <85 yrs or > or =85 yrs, and 3) body mass index (BMI) <50 or > or =50 kg/m. Length of stay (LOS), functional independence measure (FIM) scores (total, motor, and cognitive), hospital charges, FIM efficiency, and discharge disposition were analyzed.
BTKA improved total FIM score more than UTKA (43 vs. 38%; P = 0.039). TKA with BMI > or =50 kg/m had similar admission and discharge FIM motor scores compared with BMI <50 kg/m (P > 0.05). TKA patients > or =85 yrs had lower admission FIM scores, longer LOS (11.3 vs. 9.4 days), and 22% higher total charges than TKA patients younger than 85 yrs (P = 0.042). THA patients > or =85 yrs had 6-10% lower total FIM, FIM motor, and FIM cognition scores and were discharged to home less frequently than younger patients (P < 0.05). Total and daily charges were 21-162% higher in THA patients with BMIs > or =50 kg/m than in THA patients with BMIs <50 kg/m (P < 0.045).
All patients made functional gains during rehabilitation. However, the most costly and lengthy rehabilitation occurred in TKA patients > or =85 yrs and THA patients with BMI > or =50 kg/m.
使用2004年医疗保险75%规则标准分析全膝关节置换术（TKA）和全髋关节置换术（THA）患者的住院康复结局。
这项回顾性研究比较了跨学科住院康复后单侧TKA（UTKA）、双侧TKA（BTKA）和THA的结局（n = 867）。患者被分为三组进行比较：1）UTKA或BTKA，2）年龄<85岁或≥85岁，3）体重指数（BMI）<50或≥50 kg/m²。分析了住院时间（LOS）、功能独立性测量（FIM）评分（总分、运动和认知）、医院费用、FIM效率和出院处置情况。
BTKA的FIM总分改善程度高于UTKA（43%对38%；P = 0.039）。BMI≥50 kg/m²的TKA患者与BMI<50 kg/m²的患者相比，入院和出院时的FIM运动评分相似（P>0.05）。≥85岁的TKA患者入院时的FIM评分较低，住院时间较长（11.3天对9.4天），总费用比85岁以下的TKA患者高22%（P = 0.042）。≥85岁的THA患者的FIM总分、FIM运动和FIM认知评分低6 - 10%，出院回家的频率低于年轻患者（P<0.05）。BMI≥50 kg/m²的THA患者的总费用和每日费用比BMI<50 kg/m²的THA患者高21 - 162%（P<0.045）。
所有患者在康复期间功能均有改善。然而，费用最高且康复时间最长的是≥85岁的TKA患者和BMI≥50 kg/m²的THA患者。
