全膝关节置换术后 10 年内翻修的风险因素。
Risk factors for revision within 10 years of total knee arthroplasty.
机构信息
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
出版信息
Clin Orthop Relat Res. 2014 Apr;472(4):1198-207. doi: 10.1007/s11999-013-3416-6. Epub 2013 Dec 18.
BACKGROUND
An in-depth understanding of risk factors for revision TKA is needed to minimize the burden of revision surgery. Previous studies indicate that hospital and community characteristics may influence outcomes after TKA, but a detailed investigation in a diverse population is warranted to identify opportunities for quality improvement.
QUESTIONS/PURPOSES: We asked: (1) What is the frequency of revision TKA within 10 years of primary arthroplasty? (2) Which patient demographic factors are associated with revision within 10 years of TKA? (3) Which community and institutional characteristics are associated with revision within 10 years of TKA?
METHODS
We identified 301,955 patients who underwent primary TKAs in New York or California from 1997 to 2005 from statewide databases. Identifier codes were used to determine whether they underwent revision TKA. Patient, community, and hospital characteristics were analyzed using multivariable regression modeling to determine predictors for revision.
RESULTS
The frequency of revision was 4.0% at 5 years after the index arthroplasty and 8.9% at 9-years. Patients between 50 and 75 years old had a lower risk of revision than patients younger than 50 years (hazard ratio [HR], 0.47; 95% CI, 0.44, 0.50). Black patients were at increased risk for needing revision surgery (HR, 1.39; 95% CI, 1.29, 1.49) after adjustment for insurance type, poverty level, and education. Women (HR, 0.82; 95% CI, 0.79, 0.86) and Medicare recipients (HR, 0.82; 95% CI, 0.79, 0.86) were less likely to undergo revision surgery, whereas those from the most educated (HR, 1.09; 95% CI, 1.02, 1.16) and the poorest communities (HR, 1.08; 95% CI, 1.01, 1.15) had modest increases in risk of revision. Mid-volume hospitals (200-400 annual cases) had a reduction of early revision (HR, 0.91; 95% CI, 0.83, 0.99) compared with those performing less than 200 cases annually, whereas higher-volume hospitals (greater than 400 cases) showed little effect compared with low-volume hospitals.
CONCLUSIONS
Patient, community, and institutional characteristics affect the risk for revision within 10 years of index TKA. These data can be used to develop process improvement and implant surveillance strategies among high-risk patients.
LEVEL OF EVIDENCE
Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
背景
深入了解翻修 TKA 的风险因素对于将翻修手术的负担降到最低至关重要。先前的研究表明，医院和社区的特征可能会影响 TKA 后的结果，但需要在多样化的人群中进行详细调查，以确定质量改进的机会。
问题/目的：我们提出了以下问题：（1）初次关节置换后 10 年内翻修 TKA 的频率是多少？（2）哪些患者人口统计学因素与 10 年内 TKA 翻修相关？（3）哪些社区和机构特征与 10 年内 TKA 翻修相关？
方法
我们从 1997 年至 2005 年从全州数据库中确定了在纽约或加利福尼亚州接受初次 TKA 的 301,955 名患者。使用标识符代码确定他们是否接受了翻修 TKA。使用多变量回归模型分析患者、社区和医院特征，以确定翻修的预测因素。
结果
初次关节置换后 5 年的翻修率为 4.0%，9 年时为 8.9%。50 至 75 岁的患者比 50 岁以下的患者进行翻修的风险更低（风险比[HR]，0.47；95%置信区间[CI]，0.44，0.50）。调整保险类型、贫困水平和教育程度后，黑人患者接受翻修手术的风险增加（HR，1.39；95%CI，1.29，1.49）。女性（HR，0.82；95%CI，0.79，0.86）和医疗保险受益人（HR，0.82；95%CI，0.79，0.86）进行翻修手术的可能性较小，而来自受教育程度最高（HR，1.09；95%CI，1.02，1.16）和最贫困社区（HR，1.08；95%CI，1.01，1.15）的患者翻修风险略有增加。中等容量医院（每年 200-400 例）与每年进行少于 200 例手术的医院相比，早期翻修的风险降低（HR，0.91；95%CI，0.83，0.99），而高容量医院（大于 400 例）与低容量医院相比，效果较小。
结论
患者、社区和机构特征影响初次 TKA 后 10 年内的翻修风险。这些数据可用于制定高风险患者的流程改进和植入物监测策略。
证据水平
III 级，治疗研究。有关证据水平的完整描述，请参阅作者说明。
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