择期初次全关节置换术后 30 天再入院的发生率和危险因素:来自 ACS-NSQIP 的分析。

Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP.

机构信息

Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, Iowa City, Iowa.

出版信息

J Arthroplasty. 2013 Oct;28(9):1499-504. doi: 10.1016/j.arth.2013.06.032. Epub 2013 Jul 26.

Abstract

Recently, the government has moved towards public reporting of 30-day readmission rates after elective primary total knee (TKA) and total hip arthroplasty (THA). We identified 11,814 and 8105 patients who underwent primary TKA and THA from the 2011 ACS NSQIP. Overall readmission rates within 30-days of surgery were 4.6% for TKA and 4.2% for THA. Complications associated with readmission were predominantly wound infections, sepsis, thromboembolic, cardiac, and respiratory related. In TKA, multivariate analysis identified age (P=0.002), male gender (P=0.03), cancer history (P=0.008), elevated BUN (P=0.002), a bleeding disorder (P<0.001) and high ASA class (P<0.001) as predictors of readmission. In THA, obesity (P=0.008), steroid use (P=0.037), a bleeding disorder (P=0.002), dependent functional status (P=0.022), and high ASA class (P<0.001) predicted readmission. Understanding characteristics associated with readmission will be essential for equitable patient risk stratification.

摘要

最近,政府已经开始推行选择性初次全膝关节置换术(TKA)和全髋关节置换术(THA)术后 30 天再入院率的公开报告。我们从 2011 年美国外科医师学会全国手术质量改进计划(ACS NSQIP)中确定了 11814 名和 8105 名接受初次 TKA 和 THA 的患者。手术 30 天内的总体再入院率分别为 TKA 的 4.6%和 THA 的 4.2%。再入院相关的并发症主要是伤口感染、脓毒症、血栓栓塞、心脏和呼吸相关问题。在 TKA 中,多变量分析确定年龄(P=0.002)、男性性别(P=0.03)、癌症病史(P=0.008)、BUN 升高(P=0.002)、出血性疾病(P<0.001)和高 ASA 分级(P<0.001)是再入院的预测因素。在 THA 中,肥胖(P=0.008)、类固醇使用(P=0.037)、出血性疾病(P=0.002)、依赖功能状态(P=0.022)和高 ASA 分级(P<0.001)预测再入院。了解与再入院相关的特征对于公平的患者风险分层至关重要。

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