Sutton Nadia, Schmitz Niels-Derrek, Johnston Stephen S
Associate Director, Ethicon, Johnson & Johnson, Franchise Health Economics and Market Access, Somerville, NJ, US.
Franchise Medical Director, Ethicon, Johnson & Johnson, Research & Development Medical Affairs, Norderstedt, Germany.
J Wound Care. 2018 Apr 1;27(Sup4):S12-S22. doi: 10.12968/jowc.2018.27.Sup4.S12.
To compare economic and clinical outcomes between skin staples and 2-octyl cyanoacrylate plus polymer mesh tape, Dermabond Prineo skin closure system, (SCS) among patients undergoing total knee replacement (TKR).
Retrospective, observational study using the Premier Healthcare Database, which comprises hospital administrative and billing data for over 700 hospitals in the US. Patients selected for study had an elective hospital admission, with discharge occurring between January 2012 and September 2015, carrying primary ICD-9-CM procedure and diagnosis codes for TKR and osteoarthritis. Patients were classified into two mutually-exclusive groups based on billing records during the index admission: those with billing record(s) for the skin closure system (SCS group); and those with billing record(s) for skin staples (staple group). Primary outcomes were index admission's length of stay (LOS), total hospital costs, and discharge status (skilled nursing facility (SNF)/other versus home/home health-care); exploratory outcomes included operating room time (ORT) during index admission and 30, 60, and 90-day readmissions. The SCS and staple groups were propensity score matched (1:1/nearest neighbour/caliper=0.10) on patient, hospital, and provider characteristics. Multivariable regressions accounting for hospital-level clustering after matching were used to compare outcomes between study groups.
Each group comprised 971 patients (1942 total patients; mean age: 65.3 years; female: 63.5%). The groups were generally well-balanced on matching covariates: mean standardised difference calculated across 49 covariates=0.049. Compared with the staple group, the SCS group had statistically significant shorter LOS (2.8 days versus 3.2 days, p=0.002), lower rate of discharge to SNF/other versus home/home health-care (26.4% versus 38.5%, p=0.011), and lower rate of 30, 60, and 90-day readmissions (30-day, 1.8% versus 4.4%, p=0.006; 60-day, 3.0% versus 5.4%, p<0.001; 90-day, 5.4% versus 7.4%, p=0.016). Differences between the groups for other outcomes were not statistically significant.
Among patients undergoing TKR, use of the SCS was associated with shorter LOS, less resource intensive discharge status, and lower rates of all-cause readmission as compared with skin staples.
比较在接受全膝关节置换术（TKR）的患者中，皮肤钉合器与2-氰基丙烯酸辛酯加聚合物网状胶带（Dermabond Prineo皮肤闭合系统，SCS）的经济和临床结局。
采用回顾性观察研究，使用Premier医疗数据库，该数据库包含美国700多家医院的医院管理和计费数据。入选研究的患者为择期住院患者，于2012年1月至2015年9月期间出院，带有TKR和骨关节炎的主要ICD-9-CM手术及诊断编码。根据索引住院期间的计费记录，将患者分为两个相互排斥的组：有皮肤闭合系统计费记录的患者（SCS组）；有皮肤钉合器计费记录的患者（钉合器组）。主要结局为索引住院的住院时间（LOS）、总住院费用和出院状态（熟练护理机构（SNF）/其他与家庭/家庭医疗护理）；探索性结局包括索引住院期间的手术室时间（ORT）以及30、60和90天再入院率。SCS组和钉合器组在患者、医院和提供者特征方面进行倾向得分匹配（1:1/最近邻/卡尺=0.10）。匹配后使用考虑医院层面聚类的多变量回归来比较研究组之间的结局。
每组包括971名患者（共1942名患者；平均年龄：65.3岁；女性：63.5%）。两组在匹配协变量上总体平衡：49个协变量的平均标准化差异=0.049。与钉合器组相比，SCS组的LOS在统计学上显著更短（2.8天对3.2天，p=0.002），出院至SNF/其他与家庭/家庭医疗护理的比例更低（26.4%对38.5%，p=0.011），30、60和90天再入院率更低（30天，1.8%对4.4%，p=0.006；60天，3.0%对5.4%，p<0.001；90天，5.4%对7.4%，p=0.016）。两组在其他结局方面的差异无统计学意义。
在接受TKR的患者中，与皮肤钉合器相比，使用SCS与更短的LOS、资源消耗更少的出院状态以及更低的全因再入院率相关。
