Reynolds Bill, Maister Nick, Gill Stephen D, Waring Shaun, Schoch Peter, Beattie Sally, Thomson Andrew, Page Richard S
Physiotherapy Department, Barwon Health, Geelong, VIC, 3220, Australia.
Orthopaedic Department, Barwon Health, Geelong, Victoria, 3220, Australia.
BMC Musculoskelet Disord. 2018 Mar 27;19(1):91. doi: 10.1186/s12891-018-2005-y.
The number of hip and knee arthroplasties completed is expected to double over the next decade. In public hospitals, regular post-arthroplasty orthopaedic review has commonly occurred for the duration of a patient's life, which requires substantial outpatient resources. However, there is limited evidence regarding the utility of these reviews for identifying complications. The current study investigated when and where complications requiring re-operation were identified following primary hip or knee arthroplasty.
The medical records of all patients requiring re-operation for complications following primary hip arthroplasty (n = 48, 2004 to 2015) or knee primary arthroplasty (n = 50, 1998 to 2015) at a large regional health service were evaluated. Data were extracted by one of four investigators using a standardised electronic data extraction tool. Variables of interest included the health setting where the complication was initially identified, how long following the original operation the complication was identified and whether the complication was symptomatic.
Routine post-arthroplasty orthopaedic appointments identified 15 (15.3%) complications requiring re-operation; all were identified in the first-year post-surgery. For each complication identified in the first-year post-surgery, approximately 1000 orthopaedic outpatient appointments were required. After the first year, all complications were identified in Emergency Departments (n = 30, 30.6%), General Practice (n = 24, 24.5%) or non-routine orthopaedic outpatient appointments (n = 19, 19.4%). All patients with complications reported symptoms.
Routine post-arthroplasty review appointments were an inefficient mechanism for identifying complications requiring re-operation more than one year following surgery. Public health services should consider assessing and redesigning post-arthroplasty review services to reduce the burden on patients and the demand for outpatient appointments.
预计在未来十年内，完成的髋关节和膝关节置换手术数量将翻倍。在公立医院，患者一生中通常会定期进行关节置换术后骨科复查，这需要大量的门诊资源。然而，关于这些复查对识别并发症的效用的证据有限。当前研究调查了初次髋关节或膝关节置换术后需要再次手术的并发症在何时何地被识别出来。
对某大型地区卫生服务机构中所有因初次髋关节置换术后并发症（n = 48，2004年至2015年）或膝关节初次置换术后并发症（n = 50，1998年至2015年）而需要再次手术的患者的病历进行评估。由四名研究人员之一使用标准化电子数据提取工具提取数据。感兴趣的变量包括最初识别出并发症的医疗机构、在初次手术后多久识别出并发症以及并发症是否有症状。
关节置换术后常规骨科门诊预约识别出15例（15.3%）需要再次手术的并发症；所有这些并发症均在术后第一年被识别出来。对于在术后第一年识别出的每例并发症而言，大约需要1000次骨科门诊预约。在第一年之后，所有并发症均在急诊科（n = 30, 30.6%）、全科医疗（n = 24, 24.5%）或非常规骨科门诊预约（n = 19,
19.4%）中被识别出来。所有有并发症的患者均报告了症状。
关节置换术后常规复查预约对于识别术后一年以上需要再次手术的并发症而言是一种低效机制。公共卫生服务机构应考虑评估和重新设计关节置换术后复查服务，以减轻患者负担和减少门诊预约需求。
