Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, Illinois.
Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Arthroplasty. 2018 May;33(5):1477-1480. doi: 10.1016/j.arth.2017.11.039. Epub 2017 Nov 29.
The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments.
Via Current Procedural Terminology codes, the National Surgical Quality Improvement Project data files were queried for all patients who underwent primary THA and conversion of previous hip surgery to THA from 2005 to 2014. To better understand the isolated effect of procedure type on adverse outcomes, primary and conversion cohorts were then propensity-score matched via logistic regression modeling. Comparisons of the study's primary outcomes were drawn between matched cohorts. Statistical significance was defined by a P-value less than or equal to .05.
Relative to the primary THA group, the conversion THA group had statistically greater rates of Center Medicare and Medicaid Services (CMS) complications (7.5% vs 4.5%), non-home bound discharge (19.6% vs 14.7%), and longer length of hospital stay. Conversion THA was associated with increased likelihood of CMS complications (odds ratio 1.68, confidence interval 1.39-2.02) and non-home bound discharge (odds ratio 1.41, confidence interval 1.25-1.58). No statistically significant differences in mortality and readmission were detected.
The elevated risk for CMS-reported complications, increased length of hospital stay, and non-home bound discharge seen in our study of conversion THA indicates that it is dissimilar to elective primary THA and likely warrants consideration for modified treatment within the Comprehensive Care for Joint Replacement structure in a manner similar to THA for fracture.
随着美国髋部骨折负担的增加，以及其他疾病的治疗需求，先前髋关节手术转为全髋关节置换术（转换 THA）的需求可能会增加。因此，有必要进行结果分析，以便在捆绑支付时代更好地为基于价值的报销计划提供信息。
通过当前手术程序分类法，从 2005 年至 2014 年，通过国家手术质量改进计划数据文件查询所有接受初次 THA 和先前髋关节手术转为 THA 的患者的记录。为了更好地了解手术类型对不良结果的单独影响，通过逻辑回归模型对初次和转换队列进行倾向评分匹配。在匹配的队列之间对研究的主要结果进行比较。统计学意义定义为 P 值小于或等于 0.05。
与初次 THA 组相比，转换 THA 组 CMS 并发症发生率（7.5% vs. 4.5%）、非居家出院率（19.6% vs. 14.7%）和住院时间更长。转换 THA 与 CMS 并发症（优势比 1.68，置信区间 1.39-2.02）和非居家出院（优势比 1.41，置信区间 1.25-1.58）的可能性增加相关。未发现死亡率和再入院率存在统计学差异。
我们对转换 THA 的研究表明，CMS 报告的并发症、住院时间延长和非居家出院的风险增加表明，其与择期初次 THA 不同，可能需要在综合关节置换护理结构中考虑进行修改治疗，类似于骨折的 THA。
