Padegimas Eric M, Kreitz Tyler M, Zmistowski Benjamin, Teplitsky Seth L, Namdari Surena, Purtill James J, Hozack William J, Chen Antonia F
Orthopedics. 2018 Jan 1;41(1):e84-e91. doi: 10.3928/01477447-20171127-04. Epub 2017 Dec 1.
This study compared perioperative outcomes for total knee arthroplasty (TKA) at an orthopedic specialty hospital and a tertiary referral center. The authors identified all primary TKA procedures performed in 2014 at the 2 facilities. Each patient at the orthopedic specialty hospital was manually matched to a patient at the tertiary referral center according to demographic and clinical variables. Matching was blinded to outcomes. Outcomes were 90-day readmission, mortality rate, reoperation, length of stay, and use of inpatient rehabilitation. Each group had 215 TKA patients. The 2 groups of patients were similar in age (66.8 years, P=.98), body mass index (30.4 kg/m, P=.99), age-adjusted Charlson Comorbidity Index (3.4, P=1.00), and sex (46.0% male, P=1.00). Mean length of stay was 1.47±0.62 days at the orthopedic specialty hospital vs 1.87±0.75 days (P<.01) at the tertiary referral center. There were 3 readmissions at the orthopedic specialty hospital and 6 readmissions at the tertiary referral center (P=.31). There were 6 reoperations at the orthopedic specialty hospital and 5 at the tertiary referral center (P=.76). In addition, 8 patients at the orthopedic specialty hospital used inpatient rehabilitation vs 15 patients at the tertiary referral center (P=.08). One patient who was treated at the orthopedic specialty hospital required transfer to a tertiary referral center. This study found that perioperative outcomes were similar for matched patients who underwent primary TKA at an orthopedic specialty hospital and a tertiary referral center. Patients treated at the orthopedic specialty hospital spent 0.4 fewer days in the hospital compared with matched patients who were treated at the tertiary referral center. This equals 2 fewer hospital nights for every 5 TKA patients. [Orthopedics. 2018; 41(1):e84-e91.].
本研究比较了在一家骨科专科医院和一家三级转诊中心进行全膝关节置换术（TKA）的围手术期结果。作者确定了2014年在这两家机构进行的所有初次TKA手术。根据人口统计学和临床变量，将骨科专科医院的每位患者与三级转诊中心的一位患者进行人工匹配。匹配过程对结果是盲法的。结果指标包括90天再入院率、死亡率、再次手术率、住院时间以及住院康复的使用情况。每组有215例TKA患者。两组患者在年龄（66.8岁，P = 0.98）、体重指数（30.4 kg/m²，P = 0.99）、年龄校正的Charlson合并症指数（3.4，P = 1.00）和性别（男性占46.0%，P = 1.00）方面相似。骨科专科医院的平均住院时间为1.47±0.62天，而三级转诊中心为1.87±0.75天（P < 0.01）。骨科专科医院有3例再入院，三级转诊中心有6例再入院（P = 0.31）。骨科专科医院有6例再次手术，三级转诊中心有5例（P = 0.76）。此外，骨科专科医院有8例患者使用了住院康复，而三级转诊中心有15例（P = 0.08）。在骨科专科医院接受治疗的1例患者需要转至三级转诊中心。本研究发现，在骨科专科医院和三级转诊中心接受初次TKA的匹配患者的围手术期结果相似。与在三级转诊中心接受治疗的匹配患者相比，在骨科专科医院接受治疗的患者住院天数少0.4天。这相当于每5例TKA患者减少2个住院夜。[《骨科》。2018年；41(1):e84 - e91。]
