University of North Carolina at Charlotte and OrthoCarolina Research Institute, Charlotte, North Carolina, USA.
J Bone Joint Surg Am. 2013 Aug 21;95(16):1441-9. doi: 10.2106/JBJS.L.00373.
The safety and efficacy of simultaneous or staged bilateral total knee arthroplasty have long been debated among orthopaedic surgeons. Advocates for simultaneous bilateral total knee arthroplasty posit that the benefits of decreased costs and recovery time, with no difference in functional outcomes, outweigh the economic costs of potential complications. The purpose of the study was to conduct a cost-utility analysis comparing simultaneous bilateral total knee arthroplasty with staged bilateral total knee arthroplasty.
A Markov model was designed to compare the cost-effectiveness of simultaneous bilateral total knee arthroplasty with that of staged bilateral total knee arthroplasty. Nationwide Inpatient Sample data sets from 2004 to 2007 were used to identify 24,574 simultaneous and 382,496 unilateral procedures. On the basis of the codes of the International Classification of Diseases, Ninth Revision, Clinical Modification, perioperative complications were categorized as minor, major, and mortality, and respective probability values were calculated. Nationwide Inpatient Sample data were used to determine hospital costs conditional on procedure type and complications. Rehabilitation costs, anesthesia costs, and heath utilities were estimated from the literature. To minimize selection bias, propensity score matching was used to match the groups on comorbid conditions, socioeconomic variables, and hospital characteristics.
Using the matched sample, all complication rates were higher for the staged group. The estimated mean cost (in 2012 U.S. dollars) was $43,401 for simultaneous bilateral total knee arthroplasty compared with $72,233 for staged bilateral total knee arthroplasty. The quality-adjusted life years gained were 9.31 for simultaneous bilateral total knee arthroplasty and 9.29 for staged bilateral total knee arthroplasty. On the basis of these matched results, simultaneous bilateral total knee arthroplasty dominated staged bilateral total knee arthroplasty with lower costs and better outcomes.
On the basis of this analysis, simultaneous bilateral total knee arthroplasty is more cost-effective than staged bilateral total knee arthroplasty, with lower costs and better outcomes for the average patient. These data can inform shared medical decision-making when bilateral total knee arthroplasty is indicated.
同时或分期双侧全膝关节置换术的安全性和有效性一直是骨科医生争论的焦点。提倡同时进行双侧全膝关节置换术的人认为，减少成本和恢复时间的好处，同时不影响功能结果，超过了潜在并发症的经济成本。本研究的目的是进行成本效益分析，比较同时双侧全膝关节置换术与分期双侧全膝关节置换术。
设计了一个马尔可夫模型来比较同时双侧全膝关节置换术与分期双侧全膝关节置换术的成本效益。使用 2004 年至 2007 年全国住院患者样本数据集来确定 24574 例同时和 382496 例单侧手术。根据国际疾病分类，第九修订版，临床修正的代码，围手术期并发症被分为轻微、严重和死亡率，并计算了各自的概率值。全国住院患者样本数据用于根据手术类型和并发症确定条件下的医院成本。康复成本、麻醉成本和健康效用是根据文献估算的。为了尽量减少选择偏差，使用倾向评分匹配来匹配组间的合并症、社会经济变量和医院特征。
使用匹配样本，分期组的所有并发症发生率都更高。同时双侧全膝关节置换术的估计平均成本（2012 年美元）为 43401 美元，分期双侧全膝关节置换术为 72233 美元。获得的质量调整生命年分别为同时双侧全膝关节置换术 9.31 年和分期双侧全膝关节置换术 9.29 年。基于这些匹配结果，同时双侧全膝关节置换术优于分期双侧全膝关节置换术，具有更低的成本和更好的结果。
根据这项分析，同时双侧全膝关节置换术比分期双侧全膝关节置换术更具成本效益，对普通患者来说，成本更低，结果更好。这些数据可以为双侧全膝关节置换术指征时的共同医疗决策提供信息。
