Maceroli Michael, Nikkel Lucas E, Mahmood Bilal, Ketz John P, Qiu Xing, Ciminelli Joseph, Messing Susan, Elfar John C
*Department of Orthopaedics, University of Rochester Center for Orthopaedic Population Studies, University of Rochester, Rochester, NY; and†Department of Biostatistics and Computational Biology Consulting Center, University of Rochester, Rochester, NY.
J Orthop Trauma. 2016 Nov;30(11):597-604. doi: 10.1097/BOT.0000000000000662.
To determine if hospital arthroplasty volume affects patient outcomes after undergoing total hip arthroplasty (THA) for displaced femoral neck fractures.
The Statewide Planning and Research Cooperative System database from the New York State Department of Health was used to group hospitals into quartiles based on overall THA volume from 2000 to 2010. The database was then queried to identify all patients undergoing THA specifically for femoral neck fracture during this time period. The data were analyzed to investigate outcomes between the 4 volume quartiles in 30-day and 1-year mortality, 1-year revision rate, and 90-day complication rate (readmission for dislocation, deep vein thrombosis, pulmonary embolism, prosthetic joint infection, or other complications related to arthroplasty in the treatment of femoral neck fractures with THA).
Patients undergoing THA for femoral neck fracture at hospitals in the top volume quartile had significantly lower 30-day (0.9%) and 1-year (7.51%) mortality than all other volume quartiles. There were no significant differences on pairwise comparisons between the second, third, and fourth quartiles with regard to postoperative mortality. There was no significant difference in revision arthroplasty at 1 year between any of the volume quartiles. On Cox regression analysis, THA for fracture at the lowest volume (fourth) quartile [hazard ratio (HR), 1.91; P = 0.016, 95% confidence interval (CI), (1.13-3.25)], second lowest volume (third) quartile (HR, 2.01; P = 0.013, 95% CI, 1.16-3.5) and third lowest volume (second) quartile (HR, 2.13; P = 0.005, 95% CI, 1.26-3.62) were associated with increased risk for a 1-year postoperative mortality event. Hospital volume quartile was also a significant risk factor for increased 90-day complication (pulmonary embolism/deep vein thrombosis, acute dislocation, prosthetic joint infection) following THA for femoral neck fracture. Having surgery in the fourth quartile (HR, 2.71; P < 0.001, 95% CI, 1.7-4.31), third quartile (HR, 2.61; P < 0.001, 95% CI, 1.61-4.23), and second quartile (HR, 2.41; P < 0.001, 95% CI, 1.51-3.84), all were significant risk factors for increased 90-day complication risk.
The results of this population-based study indicate that THA for femoral neck fractures at high-volume arthroplasty centers is associated with lower mortality and 90-day complication rates but does not influence 1-year revision rate. THA for femoral neck fractures at top arthroplasty volume quartile hospitals are performed on healthier patients more quickly. Patient health is a critical factor that influences mortality outcomes following THA for femoral neck fractures.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
确定医院关节置换手术量是否会影响移位型股骨颈骨折患者行全髋关节置换术（THA）后的预后。
利用纽约州卫生部的全州规划与研究合作系统数据库，根据2000年至2010年的全髋关节置换总量将医院分为四分位数组。然后查询该数据库，以确定在此期间所有因股骨颈骨折而行全髋关节置换术的患者。对数据进行分析，以研究四分位数组之间在30天和1年死亡率、1年翻修率以及90天并发症发生率（因脱位、深静脉血栓形成、肺栓塞、人工关节感染或其他与全髋关节置换术治疗股骨颈骨折相关的并发症再次入院）方面的预后情况。
在手术量最高的四分位数组医院接受股骨颈骨折全髋关节置换术的患者，其30天死亡率（0.9%）和1年死亡率（7.51%）显著低于所有其他四分位数组。在术后死亡率方面，第二、第三和第四四分位数组之间的两两比较无显著差异。各四分位数组之间在1年时的关节置换翻修率无显著差异。在Cox回归分析中，手术量最低（第四）四分位数组（风险比[HR]，1.91；P = 0.016，95%置信区间[CI]，[1.13 - 3.25]）、第二低（第三）四分位数组（HR，2.01；P = 0.013，95% CI，1.16 - 3.5）和第三低（第二）四分位数组（HR，2.13；P = 0.005，95% CI，1.26 - 3.62）的股骨颈骨折全髋关节置换术与术后1年死亡事件风险增加相关。医院手术量四分位数也是股骨颈骨折全髋关节置换术后90天并发症（肺栓塞/深静脉血栓形成、急性脱位、人工关节感染）增加的显著风险因素。在第四四分位数组（HR，2.71；P < 0.001，95% CI，1.7 - 4.31）、第三四分位数组（HR，2.61；P < 0.001，95% CI，1.61 - 4.23）和第二四分位数组（HR，2.41；P < 0.001，95% CI，1.51 - 3.84）进行手术，均是90天并发症风险增加的显著风险因素。
这项基于人群的研究结果表明，在高手术量关节置换中心进行的股骨颈骨折全髋关节置换术与较低的死亡率和90天并发症发生率相关，但不影响1年翻修率。在手术量最高的四分位数组医院进行股骨颈骨折全髋关节置换术的患者更健康，手术也更快。患者健康状况是影响股骨颈骨折全髋关节置换术后死亡率结局的关键因素。
预后II级。有关证据水平的完整描述，请参阅作者指南。
