医疗保险患者初次全髋关节置换术后早期翻修的风险因素。
Risk factors for early revision after primary total hip arthroplasty in Medicare patients.
机构信息
Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320 W, San Francisco, CA, 94143-0728, USA,
出版信息
Clin Orthop Relat Res. 2014 Feb;472(2):449-54. doi: 10.1007/s11999-013-3081-9.
BACKGROUND
Patient, surgeon, health system, and device factors are all known to influence outcomes in THA. However, patient-related factors associated with an increased risk of early failure are poorly understood, particularly in elderly patients.
QUESTIONS/PURPOSES: We identified specific demographic and clinical characteristics associated with increased risk of early revision in Medicare patients with THA.
METHODS
The Medicare 5% national sample administrative database was used to calculate the relative risk of revision within 12 months following primary THA as a function of baseline medical comorbidities in 56,030 Medicare patients who underwent primary THA between 1998 and 2010. The impact of 29 comorbid conditions on risk of early revision was examined using Cox regression, controlling for age, sex, race, US Census region, socioeconomic status, and all other baseline comorbidities.
RESULTS
Depression, rheumatologic disease, psychoses, renal disease, chronic urinary tract infection, and congestive heart failure were associated with revision THA within 12 months of the index arthroplasty (p ≤ 0.038 for all comparisons; risk factors listed in order of significance).
CONCLUSIONS
This information is important when counseling elderly patients with THA regarding the risk of early failure and for risk stratifying publicly reported outcomes in Medicare patients with THA.
背景
患者、外科医生、医疗体系和器械因素均会影响全髋关节置换术（THA）的结果。然而，人们对与早期失败风险增加相关的患者相关因素知之甚少，尤其是在老年患者中。
问题/目的：我们确定了与 Medicare 接受 THA 的患者早期翻修风险增加相关的特定人口统计学和临床特征。
方法
使用 Medicare 5%全国抽样行政数据库，根据 1998 年至 2010 年间接受初次 THA 的 56,030 名 Medicare 患者的基线合并症，计算初次 THA 后 12 个月内翻修的相对风险。使用 Cox 回归检查 29 种合并症对早期翻修风险的影响，同时控制年龄、性别、种族、美国人口普查区、社会经济状况和所有其他基线合并症。
结果
抑郁、风湿性疾病、精神病、肾脏疾病、慢性尿路感染和充血性心力衰竭与指数关节置换术后 12 个月内的翻修 THA 相关（所有比较的 p 值均≤0.038；按显著程度列出风险因素）。
结论
当向接受 THA 的老年患者提供关于早期失败风险的咨询时，以及在对 Medicare 接受 THA 的患者的公共报告结果进行风险分层时，这些信息非常重要。
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