美国和加拿大初次全髋关节和全膝关节置换术的应用和短期结果：纽约和安大略省行政数据的分析。
Utilization and Short-Term Outcomes of Primary Total Hip and Knee Arthroplasty in the United States and Canada: An Analysis of New York and Ontario Administrative Data.
机构信息
University of Toronto, Sinai Health System and University Health Network, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Harvard Medical School, Boston, Massachusetts.
出版信息
Arthritis Rheumatol. 2018 Apr;70(4):547-554. doi: 10.1002/art.40407. Epub 2018 Feb 26.
OBJECTIVE
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are common and effective surgical procedures. This study sought to compare utilization and short-term outcomes of primary TKA and THA in adjacent regions of Canada and the United States.
METHODS
The study was designed as a retrospective cohort study of patients who underwent primary TKA or THA, comparing administrative data from New York and Ontario in 2012-2013. Demographic features of the TKA and THA patients, per capita utilization rates, and short-term outcomes were compared between the jurisdictions.
RESULTS
A higher percentage of New York hospitals performed TKA compared to Ontario hospitals (75.7% versus 42.1%; P < 0.001), and the mean annual procedural volume for TKAs was lower in New York hospitals (mean 179 versus 327 in Ontario hospitals; P < 0.001). After direct standardization, utilization was significantly lower in New York compared to Ontario, both for TKA (16.1 TKAs versus 21.4 TKAs per 10,000 population per year; P < 0.001) and for THA (10.5 THAs versus 11.5 THAs per 10,000 population per year; P < 0.001). For those who underwent TKA, the length of stay in Ontario hospitals was significantly longer (mean 3.7 days versus 3.4 days in New York hospitals; P < 0.001). A smaller percentage of New York patients were discharged directly home (46.2% versus 90.9% of Ontario patients; P < 0.001), but 30-day and 90-day readmission rates were higher in New York compared to Ontario (30-day rates, 4.6% versus 3.9% [P < 0.001]; 90-day rates, 8.4% versus 6.7% [P < 0.001]). For the THA cohorts, the results with regard to length of stay, discharge disposition, and readmission rates were similar to those for TKA.
CONCLUSION
Ontario has higher utilization of total joint arthroplasty than New York but has a smaller percentage of hospitals performing these procedures. Patients are more likely to be discharged home and less likely to be readmitted in Ontario. Our results suggest areas where each jurisdiction could improve.
目的
全膝关节置换术（TKA）和全髋关节置换术（THA）是常见且有效的手术。本研究旨在比较加拿大和美国毗邻地区初次 TKA 和 THA 的应用情况和短期疗效。
方法
本研究是一项回顾性队列研究，纳入了 2012 年至 2013 年在纽约和安大略省接受初次 TKA 或 THA 的患者，比较了这两个地区的人口统计学特征、人均使用率和短期疗效。
结果
与安大略省的医院相比，纽约的医院行 TKA 手术的比例更高（75.7%比 42.1%；P<0.001），纽约医院 TKA 的平均年手术量也较低（平均 179 例比安大略省的 327 例；P<0.001）。经直接标准化后，纽约 TKA 的使用率明显低于安大略省（每年每 10000 人 16.1 例比 21.4 例；P<0.001），THA 的使用率也明显低于安大略省（每年每 10000 人 10.5 例比 11.5 例；P<0.001）。对于接受 TKA 的患者，安大略省医院的住院时间明显更长（平均 3.7 天比纽约医院的 3.4 天；P<0.001）。纽约患者中直接出院回家的比例明显较低（46.2%比安大略省患者的 90.9%；P<0.001），但纽约 30 天和 90 天再入院率高于安大略省（30 天再入院率，4.6%比 3.9%[P<0.001]；90 天再入院率，8.4%比 6.7%[P<0.001]）。THA 队列的结果与 TKA 队列相似，住院时间、出院去向和再入院率均存在差异。
结论
安大略省的 TKA 和 THA 总使用率高于纽约，但开展这些手术的医院比例较小。安大略省的患者更有可能直接出院，再入院率也较低。我们的研究结果提示两个地区均有可改进之处。
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