Memtsoudis Stavros G, Besculides Melanie C, Reid Shane, Gaber-Baylis Licia K, González Della Valle Alejandro
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, USA.
Clin Orthop Relat Res. 2009 Jun;467(6):1568-76. doi: 10.1007/s11999-008-0610-z. Epub 2008 Nov 11.
Information regarding national trends in bilateral TKAs is needed for a rational allocation of resources, policy making, and research. Therefore, we analyzed data from the National Hospital Discharge Survey to elucidate temporal changes in the demographics, comorbidity profiles, hospital stay, and in-hospital complications of patients undergoing bilateral TKAs in the United States. We created three 5-year periods: 1990-1994, 1995-1999, 2000-2004. Procedure, healthcare system, and patient-related variables were analyzed for an estimated 153,259 discharges. Use of bilateral TKAs more than doubled for the entire civilian population and almost tripled among the female population, with the steepest increase seen during the last two study periods. A decline of nearly 50% in the use of bilateral TKAs in patients 85 years and older was seen between the second and third study periods. The prevalence of coronary artery disease and pulmonary disease increased from the first to the second study periods but decreased from the second to the third. The changes in the variables studied may reflect a recently acquired reluctance to perform bilateral TKAs in elderly patients with cardiopulmonary comorbidities. Additional studies are necessary to identify other causal relationships and define the impact of these changes on various aspects of the healthcare system.
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
为了合理分配资源、制定政策和开展研究，需要有关双侧全膝关节置换术（TKA）全国趋势的信息。因此，我们分析了国家医院出院调查的数据，以阐明美国接受双侧TKA患者的人口统计学、合并症概况、住院时间和院内并发症的时间变化。我们创建了三个5年时间段：1990 - 1994年、1995 - 1999年、2000 - 2004年。对估计153,259例出院病例的手术、医疗系统和患者相关变量进行了分析。双侧TKA在全体平民中的使用量增加了一倍多，在女性人群中几乎增加了两倍，在最后两个研究时间段内增长最为显著。在第二个和第三个研究时间段之间，85岁及以上患者双侧TKA的使用量下降了近50%。冠状动脉疾病和肺部疾病的患病率从第一个研究时间段到第二个研究时间段有所增加，但从第二个研究时间段到第三个研究时间段有所下降。所研究变量的变化可能反映了最近在患有心肺合并症的老年患者中对进行双侧TKA的不情愿态度。需要进一步的研究来确定其他因果关系，并确定这些变化对医疗系统各个方面的影响。
II级，预后研究。有关证据水平的完整描述，请参阅作者指南。
