Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA.
Anesthesiology. 2012 Jul;117(1):107-16. doi: 10.1097/ALN.0b013e31825afd36.
A paucity of data exist on the use of critical care services (CCS) among hip and knee arthroplasty patients. The authors sought to identify the incidence and risk factors for the use of CCS among these patients and compare the characteristics and outcomes of patients who require CCS to those who do not.
The authors analyzed hospital discharge data of patients who underwent primary hip or knee arthroplasty in approximately 400 United States hospitals between 2006 and 2010. Patient and healthcare system-related demographics for admitted patients requiring CCS were compared with those who did not. Differences in outcomes, including mortality, complications, disposition status, and hospital charges, were analyzed. Regression analysis was performed to identify risk factors for requiring CCS.
A total of 528,495 patients underwent primary total hip (n = 172,467, 33%) and knee arthroplasty (n = 356,028, 67%). Of these, 3% required CCS. On average, CCS patients were older and had a higher comorbidity burden than did patients not requiring CCS. CCS patients experienced more complications, had longer hospital stays and higher costs, and were less likely to be discharged home than were non-CCS patients. Risk factors with increased odds for requiring CCS included advanced age, use of general versus neuraxial anesthesia, and the presence of postoperative cardiopulmonary complications.
Approximately 1 of 30 patients undergoing total joint arthroplasty requires CCS. Given the large number of these procedures performed annually, anesthesiologists, orthopedic surgeons, critical care physicians, and administrators should be aware of the attendant risks this population represents and allocate resources accordingly.
关于髋膝关节置换术患者使用重症监护服务（CCS）的数据很少。作者试图确定这些患者使用 CCS 的发生率和危险因素，并比较需要和不需要 CCS 的患者的特征和结局。
作者分析了 2006 年至 2010 年间约 400 家美国医院接受初次髋或膝关节置换术的患者的住院数据。比较了需要 CCS 的入院患者和不需要 CCS 的患者的患者和医疗系统相关人口统计学特征。分析了包括死亡率、并发症、处置状态和住院费用在内的结局差异。进行回归分析以确定需要 CCS 的危险因素。
共有 528495 名患者接受了初次全髋关节（n = 172467，33%）和膝关节置换术（n = 356028，67%）。其中，3%需要 CCS。平均而言，CCS 患者比不需要 CCS 的患者年龄更大，合并症负担更重。CCS 患者发生更多并发症，住院时间更长，费用更高，出院回家的可能性低于非 CCS 患者。需要 CCS 的风险因素包括年龄较大、使用全身麻醉而非椎管内麻醉，以及术后心肺并发症。
大约每 30 名接受全关节置换术的患者中就有 1 名需要 CCS。鉴于每年进行的这些手术数量众多，麻醉师、骨科医生、重症监护医生和管理人员应意识到该人群所代表的风险，并相应地分配资源。
