Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, Pennsylvania.
American Association of Hip and Knee Surgeons, Rosemont, Illinois.
J Arthroplasty. 2018 Jul;33(7S):S23-S27. doi: 10.1016/j.arth.2017.11.028. Epub 2017 Nov 21.
The Centers for Medicare and Medicaid Services have solicited comments to consider removing total knee arthroplasty (TKA) from the Inpatient Only list, as it has done for unicompartmental knee arthroplasty (UKA). The purpose of this study is to determine whether Medicare-aged patients undergoing TKA had comparable outcomes to those undergoing UKA.
We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients aged 65 years or older who underwent elective TKA or UKA from 2014 and 2015. Demographic variables, comorbidities, length of stay (LOS), 30-day complication, and readmission rates were compared between UKA and TKA patients. A multivariate regression analysis was then performed to identify independent risk factors for complications and hospital LOS greater than 1 day.
Of the 50,487 patients in the study, there were 49,136 (97%) TKA patients and 1351 UKA patients (3%). Medicare-aged TKA patients had a longer mean LOS (2.97 vs 1.57 days, P < .001), had a higher complication rate (9% vs 3%, P < .001), and were more likely to be discharged to a rehabilitation facility (31% vs 9%, P < .001) than Medicare-aged UKA patients. When controlling for other variables, TKA patients were more likely to experience a complication (odds ratio, 2.562; P < .001) and require LOS >1 day (odds ratio, 14.679; P < .001) than UKA patients.
TKA procedure in the Medicare population is an independent risk factor for increased complications and LOS compared to UKA. Policymakers should use caution extrapolating UKA data to TKA patients and recognize the inherent disparities between the 2 procedures.
医疗保险和医疗补助服务中心已征求意见，以考虑将全膝关节置换术（TKA）从仅限住院治疗的清单中删除，就像对待单髁膝关节置换术（UKA）那样。本研究的目的是确定接受 TKA 的 Medicare 年龄段患者与接受 UKA 的患者的结果是否可比。
我们查询了美国外科医师学会-国家外科质量改进计划数据库，获取了 2014 年至 2015 年期间所有 65 岁或以上接受择期 TKA 或 UKA 的患者数据。比较 UKA 和 TKA 患者的人口统计学变量、合并症、住院时间（LOS）、30 天并发症和再入院率。然后进行多变量回归分析，以确定并发症和住院时间超过 1 天的独立危险因素。
在这项研究的 50487 名患者中，有 49136 名（97%）TKA 患者和 1351 名 UKA 患者（3%）。 Medicare 年龄段的 TKA 患者的平均 LOS 较长（2.97 天比 1.57 天，P <.001），并发症发生率较高（9%比 3%，P <.001），更有可能被送往康复机构（31%比 9%，P <.001）。在控制其他变量后，与 UKA 患者相比，TKA 患者更有可能发生并发症（优势比，2.562；P <.001）和需要 LOS >1 天（优势比，14.679；P <.001）。
与 UKA 相比， Medicare 人群中的 TKA 手术是增加并发症和 LOS 的独立危险因素。政策制定者在将 UKA 数据外推至 TKA 患者时应谨慎，并认识到这两种手术之间存在固有差异。
