Yasunaga Hideo, Tsuchiya Kazuaki, Matsuyama Yutaka, Ohe Kazuhiko
Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
J Orthop Sci. 2009 Jan;14(1):10-6. doi: 10.1007/s00776-008-1294-7. Epub 2009 Feb 13.
This study aimed to clarify the impact of various factors on the operating time, postoperative complications, and length of stay (LOS) after total knee arthroplasty (TKA).
We identified 3577 TKAs performed in 345 hospitals in Japan from November 2006 to March 2007. We examined the patient characteristics, surgical procedure details, hospital and surgeon volumes, and outcome variables (operating time, postoperative complications, LOS).
The average operating time was 127 +/- 47 min. The rate of postoperative complications was 9.8%. The average LOS was 35.1 +/- 15.9 days. In multivariate regression analyses, the average operating times were significantly shorter at hospitals with > or = 50 cases per year compared to hospitals with < 10 cases per year and for surgeons with > or =100 total cases compared to surgeons with < 100 total cases. A longer operating time was associated with revision surgery and use of computer navigation. Significant predictors of postoperative complications were age, body mass index, and cerebrovascular disease. Shorter LOS was associated with higher hospital volume and use of a clinical pathway, whereas age, cardiovascular disease, and revision surgery increased the length of stay.
Postoperative complications following TKA mainly depended on patient-based factors and were not significantly affected by the surgeon's experience.
本研究旨在阐明全膝关节置换术（TKA）后各种因素对手术时间、术后并发症及住院时间（LOS）的影响。
我们确定了2006年11月至2007年3月期间在日本345家医院进行的3577例TKA手术。我们检查了患者特征、手术操作细节、医院和外科医生手术量以及结果变量（手术时间、术后并发症、住院时间）。
平均手术时间为127±47分钟。术后并发症发生率为9.8%。平均住院时间为35.1±15.9天。在多因素回归分析中，每年手术量≥50例的医院与每年手术量<10例的医院相比，平均手术时间显著更短；手术总量≥100例的外科医生与手术总量<100例的外科医生相比，平均手术时间显著更短。手术时间延长与翻修手术及使用计算机导航有关。术后并发症的显著预测因素为年龄、体重指数和脑血管疾病。住院时间较短与医院手术量较高及采用临床路径有关，而年龄、心血管疾病和翻修手术会延长住院时间。
TKA术后并发症主要取决于患者因素，而外科医生的经验对其影响不显著。
