Sikora-Klak Jakub, Zarling Bradley, Bergum Christopher, Flynn Jeffrey C, Markel David C
Department of Orthopaedic Research, Providence-Providence Park Hospital, Southfield, Michigan; Department of Orthopaedics, The CORE Institute, Southfield, Michigan.
J Arthroplasty. 2017 May;32(5):1414-1417. doi: 10.1016/j.arth.2016.11.035. Epub 2016 Nov 29.
As the annual demand and number of total joint arthroplasty cases increase, so do concerns of outcomes of patient with specific comorbidities relative to outcomes and costs of care.
The study cohort included 2009 primary total knee arthroplasty (TKA) patients and 905 total hip arthroplasty patients. Discharge disposition was classified as discharge to any facility or home. The comorbidities of the patients who were readmitted and those without a 90-day event were also evaluated.
In the TKA population, age, female gender, nonsmoking status, venous thromboembolism (VTE) history, and diabetes were significantly associated with discharge to extended care facility (ECF) on univariate analysis, unlike body mass index. With multivariate analyses, female gender, age, VTE history, and diabetes were associated with ECF placement, but smoking was not. In the total hip arthroplasty population, age, female gender, and nonsmoking status were significantly associated with discharge to ECF on univariate analysis, whereas body mass index, diabetes, and VTE history were not. On multivariate analyses, female gender and age were associated with ECF, but smoking was not. The only significant finding for the readmission data was an increased rate of readmission for TKA patients of older age.
The potential of projecting patient discharge and readmission allows physicians to counsel patients and improve patient expectations.
随着全关节置换病例的年度需求和总数增加，对于患有特定合并症患者的治疗结果及护理成本的担忧也与日俱增。
研究队列包括2009例初次全膝关节置换（TKA）患者和905例全髋关节置换患者。出院处置分为出院至任何机构或回家。还对再次入院患者和无90天事件患者的合并症进行了评估。
在TKA人群中，单因素分析显示年龄、女性、非吸烟状态、静脉血栓栓塞（VTE）病史和糖尿病与出院至长期护理机构（ECF）显著相关，而体重指数则不然。多因素分析显示，女性、年龄、VTE病史和糖尿病与入住ECF相关，但吸烟无关。在全髋关节置换人群中，单因素分析显示年龄、女性和非吸烟状态与出院至ECF显著相关，而体重指数、糖尿病和VTE病史则不然。多因素分析显示，女性和年龄与入住ECF相关，但吸烟无关。再次入院数据的唯一显著发现是老年TKA患者的再入院率增加。
预测患者出院和再入院的可能性使医生能够为患者提供咨询并提高患者期望。
