Kowalik Thomas D, DeHart Matthew, Gehling Hanne, Gehling Paxton, Schabel Kathryn, Duwelius Paul, Mirza Amer
From the Department of Orthopaedics, Oregon Health and Science University, Portland, OR (Dr. Kowalik, Dr. Schabel, and Paxton Gehling), Providence Health and Services, Portland (Mr. DeHart and Hanne Gehling), Orthopedic & Fracture Specialists, Portland (Dr. Duwelius), and Summit Orthopaedics, Portland (Dr. Mirza).
J Am Acad Orthop Surg. 2016 Jun;24(6):393-8. doi: 10.5435/JAAOS-D-15-00596.
The purpose of this study was to examine the epidemiology of primary and revision total hip arthroplasty (THA) in teaching and nonteaching hospitals.
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried from 2006 to 2010 to identify primary and revision THAs at teaching and nonteaching hospitals.
A total of 1,336,396 primary and 223,520 revision procedures were identified. Forty-six percent of all primary and 54% of all revision procedures were performed at teaching hospitals. Teaching hospitals performed 17% of their THAs as revisions; nonteaching hospitals performed 12% as revisions. For primary and revision THAs, teaching hospitals had fewer patients aged >65 years, fewer Medicare patients, similar gender rates, more nonwhite patients, and more patients in the highest income quartile compared with nonteaching hospitals. Costs, length of stay, and Charlson Comorbidity Index scores were similar; however, the mortality rate was lower at teaching hospitals.
This study found small but significant differences in key epidemiologic and outcome variables in examining primary and revision THA at teaching and nonteaching hospitals.
Level III.
本研究的目的是调查教学医院和非教学医院初次及翻修全髋关节置换术（THA）的流行病学情况。
查询2006年至2010年医疗成本和利用项目全国住院患者样本，以确定教学医院和非教学医院的初次及翻修THA。
共识别出1336396例初次手术和223520例翻修手术。所有初次手术的46%以及所有翻修手术的54%在教学医院进行。教学医院进行的THA中有17%为翻修手术；非教学医院为12%。与非教学医院相比，教学医院进行初次及翻修THA时，年龄>65岁的患者较少，医疗保险患者较少，性别比例相似，非白人患者较多，收入最高四分位数的患者较多。成本、住院时间和查尔森合并症指数评分相似；然而，教学医院的死亡率较低。
本研究发现，在调查教学医院和非教学医院的初次及翻修THA时，关键流行病学和结果变量存在微小但显著的差异。
三级。
