门诊全肩关节置换术：当前趋势、并发症、再入院情况及成本的综合分析
Ambulatory Total Shoulder Arthroplasty: A Comprehensive Analysis of Current Trends, Complications, Readmissions, and Costs.
作者信息
Cancienne Jourdan M, Brockmeier Stephen F, Gulotta Lawrence V, Dines David M, Werner Brian C
机构信息
1Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
出版信息
J Bone Joint Surg Am. 2017 Apr 19;99(8):629-637. doi: 10.2106/JBJS.16.00287.
BACKGROUND
There have been few studies that have evaluated ambulatory total shoulder arthroplasty. The objectives of the present study were to investigate the current trends in ambulatory total shoulder arthroplasty in the United States; to characterize the rate of postoperative complications, hospital readmission, and risk factors associated with readmission; and to conduct a cost analysis comparing ambulatory total shoulder arthroplasty with matched inpatient total shoulder arthroplasty.
METHODS
A national insurance database was queried for patients who underwent anatomic total shoulder arthroplasty between the fourth quarter of 2010 and 2014. Patients undergoing ambulatory total shoulder arthroplasty and a matched group of patients undergoing inpatient total shoulder arthroplasty were identified. Complications were assessed for both groups. Risk factors for readmission within 90 days postoperatively were examined. The costs up to 30 days postoperatively were evaluated for patients who underwent ambulatory total shoulder arthroplasty and controls.
RESULTS
Included in the study were 706 patients who underwent ambulatory total shoulder arthroplasty. From the fourth quarter of 2010 to 2014, the yearly incidence of ambulatory total shoulder arthroplasty doubled. In the study, 4,459 patients who underwent inpatient total shoulder arthroplasty were matched to patients who underwent ambulatory total shoulder arthroplasty. In no instances were any complications present at a significantly higher rate in the patients who underwent ambulatory total shoulder arthroplasty. The rate of readmission was not significantly different (p > 0.05) between the 2 cohorts. The patients undergoing ambulatory total shoulder arthroplasty had significantly lower costs (p < 0.0001) at $14,722 compared with the matched controls at $18,336 in numerous itemized cost categories as well as costs related to diagnosis-related groups.
CONCLUSIONS
In appropriately selected patients, ambulatory total shoulder arthroplasty is a viable and safe practice model. Ambulatory total shoulder arthroplasty also offers significant cost savings compared with inpatient total shoulder arthroplasty in matched patients.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
评估非住院全肩关节置换术的研究较少。本研究的目的是调查美国非住院全肩关节置换术的当前趋势；描述术后并发症发生率、再次入院率以及与再次入院相关的危险因素；并进行成本分析，比较非住院全肩关节置换术与匹配的住院全肩关节置换术。
方法
查询国家保险数据库，以获取2010年第四季度至2014年期间接受解剖型全肩关节置换术的患者。确定接受非住院全肩关节置换术的患者以及匹配的接受住院全肩关节置换术的患者组。评估两组的并发症情况。检查术后90天内再次入院的危险因素。对接受非住院全肩关节置换术的患者及其对照组术后30天内的费用进行评估。
结果
本研究纳入了706例接受非住院全肩关节置换术的患者。从2010年第四季度到2014年，非住院全肩关节置换术的年发病率翻了一番。在研究中，4459例接受住院全肩关节置换术的患者与接受非住院全肩关节置换术的患者进行了匹配。接受非住院全肩关节置换术的患者中，任何并发症的发生率均无显著更高。两组之间的再次入院率无显著差异（p>0.05）。在众多分项成本类别以及与诊断相关组相关的成本方面，接受非住院全肩关节置换术的患者成本显著更低（p<0.0001），为14,722美元，而匹配对照组为18,336美元。
结论
在适当选择的患者中，非住院全肩关节置换术是一种可行且安全的实践模式。与匹配患者的住院全肩关节置换术相比，非住院全肩关节置换术也能显著节省成本。
证据水平
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
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