Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH.
Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH; Department of Orthopaedic Surgery, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
J Arthroplasty. 2018 Jun;33(6):1908-1913. doi: 10.1016/j.arth.2017.12.020. Epub 2017 Dec 28.
The time of year might influence the occurrence of surgical complications. Therefore, this study investigated correlations between the time-of-year and 30-day postoperative complication rates following primary total knee arthroplasty (TKA). Specifically, we determined (1) postoperative complication rates across all quarters; and (2) time-of-year influence on complications using univariate and multivariate regression analyses.
CPT code 27447 identified 147,473 TKAs from the NSQIP database. Readmissions, reoperations, as well as medical and surgical complications occurring within 30 postoperative days were assessed. All TKAs were divided into 4 cohorts based on the quarter-of-the-year (Q1-Q4) during which the surgery was performed. Chi-Square, ANOVA, linear regression, as well as univariate and multivariate analyses were performed to compare complication rates. A P < .05 was set for statistical significance.
Q3 had a higher risk of superficial infection when compared to Q1 (OR 1.37; 95% CI 1.12-1.69; P = .002). There was a lower risk of pneumonia between Q2 and Q1 (OR: 0.7; 95% CI 0.54-0.90; P = .007) as well as Q4 and Q1 (OR 0.76; 95% CI 0.6-0.96; P = .017). Blood transfusion was lower in Q2, Q3, and Q4 compared to Q1 (P = .02, P < .001, and P < .001).
This study provides a baseline analysis correlating the time of year and outcomes of TKA. However, since seasonality and weather can vary greatly in the United States by geographic region and time of year, future studies should be performed at a more granular level using hospital-specific data correlating weather and region to TKA outcomes.
一年中的时间可能会影响手术并发症的发生。因此，本研究调查了初次全膝关节置换术（TKA）后 30 天内的季节与术后并发症发生率之间的相关性。具体而言，我们确定了（1）所有季度的术后并发症发生率；以及（2）使用单变量和多变量回归分析确定季节对并发症的影响。
从 NSQIP 数据库中使用 CPT 代码 27447 确定了 147,473 例 TKA。评估了术后 30 天内发生的再入院、再次手术以及医疗和手术并发症。所有 TKA 根据手术进行的季度（Q1-Q4）分为 4 组。使用卡方检验、方差分析、线性回归以及单变量和多变量分析来比较并发症发生率。统计学显著性设定为 P <.05。
与 Q1 相比，Q3 发生浅表感染的风险更高（OR 1.37；95%CI 1.12-1.69；P =.002）。与 Q1 相比，Q2 和 Q4 发生肺炎的风险较低（OR：0.7；95%CI 0.54-0.90；P =.007），Q4 和 Q1 也较低（OR 0.76；95%CI 0.6-0.96；P =.017）。与 Q1 相比，Q2、Q3 和 Q4 的输血率较低（P =.02，P <.001，P <.001）。
本研究提供了与 TKA 结果相关的时间与结果的基线分析。然而，由于美国不同地理位置和季节的季节性和天气差异很大，因此应在更精细的水平上使用与天气和 TKA 结果相关的特定医院数据进行未来研究。
