Odum Susan M, Springer Bryan D
OrthoCarolina Research Institute, Inc., 2001 Vail Avenue, Suite 300, Charlotte, NC 28207. E-mail address:
OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Suite 200-A, Charlotte, NC 28207. E-mail address:
J Bone Joint Surg Am. 2014 Jul 2;96(13):1058-1065. doi: 10.2106/JBJS.M.00065.
Data comparing complication rates following simultaneous bilateral total knee arthroplasty with those of unilateral total knee arthroplasty are conflicting. The purpose of this study was to compare in-hospital complication rates following simultaneous bilateral versus unilateral total knee arthroplasty and to determine factors associated with in-hospital complication rates in a large cohort of patients identified from the Nationwide Inpatient Sample (NIS).
The 2004 to 2007 NIS data set was used to identify 407,070 total knee arthroplasties: 24,574 simultaneous bilateral and 382,496 unilateral total knee arthroplasties. Complications, based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, were categorized as none, minor, major, or mortality. Covariates included comorbidities, demographic information, payer type, and hospital total knee arthroplasty volume. Multiple logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
Simultaneous bilateral total knee arthroplasty was associated with significantly higher odds of an in-hospital complication compared with unilateral total knee arthroplasty: OR, 1.51 (95% CI, 1.42 to 1.62) for minor complication; OR, 1.30 (95% CI, 1.14 to 1.47) for major complication; and OR, 2.51 (95% CI, 1.66 to 3.80) for mortality. Patients with greater numbers of medical comorbidities were more likely to have an in-hospital complication. Compared with whites, African-American and Asian/Pacific Islander groups had significantly higher odds of a minor complication. Female patients were less likely than male patients to have an in-hospital complication. Patients who were less than sixty-five years old at the time of surgery had significantly reduced odds of a minor complication and mortality compared with patients who were seventy-five years of age or older. Compared with hospitals with a very-high volume of total knee arthroplasty procedures performed (≥850), lower-volume hospitals had significantly increased odds of minor complications and mortality.
While complication rates following either unilateral or simultaneous bilateral total knee arthroplasty are low, simultaneous bilateral total knee arthroplasty was associated with higher odds of in-hospital complications, including mortality, compared with unilateral total knee arthroplasty. Patient demographic information, preoperative health status, payer type, and hospital total knee arthroplasty volume were all significant factors in complication rates following bilateral total knee arthroplasty.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
关于同期双侧全膝关节置换术与单侧全膝关节置换术并发症发生率的比较数据相互矛盾。本研究的目的是比较同期双侧与单侧全膝关节置换术后的院内并发症发生率，并确定在从全国住院患者样本（NIS）中识别出的大量患者队列中与院内并发症发生率相关的因素。
使用2004年至2007年的NIS数据集识别出407,070例全膝关节置换术：24,574例同期双侧和382,496例单侧全膝关节置换术。根据国际疾病分类第九版临床修订本（ICD - 9 - CM）编码，将并发症分为无、轻度、重度或死亡。协变量包括合并症、人口统计学信息、支付方类型和医院全膝关节置换手术量。采用多因素逻辑回归计算比值比（OR）和95%置信区间（CI）。
与单侧全膝关节置换术相比，同期双侧全膝关节置换术与院内并发症发生几率显著更高相关：轻度并发症的OR为1.51（95%CI，1.42至1.62）；重度并发症的OR为1.30（95%CI，1.14至1.47）；死亡的OR为2.51（95%CI，1.66至3.80）。合并症数量较多的患者更有可能发生院内并发症。与白人相比，非裔美国人和亚裔/太平洋岛民组发生轻度并发症的几率显著更高。女性患者发生院内并发症的可能性低于男性患者。与75岁及以上的患者相比，手术时年龄小于65岁的患者发生轻度并发症和死亡的几率显著降低。与全膝关节置换手术量非常高（≥850例）的医院相比，手术量较低的医院发生轻度并发症和死亡的几率显著增加。
虽然单侧或同期双侧全膝关节置换术后的并发症发生率较低，但与单侧全膝关节置换术相比，同期双侧全膝关节置换术与包括死亡在内的院内并发症发生几率更高相关。患者人口统计学信息、术前健康状况、支付方类型和医院全膝关节置换手术量都是双侧全膝关节置换术后并发症发生率的重要因素。
治疗性水平III。有关证据水平的完整描述，请参阅作者指南。
