Arshi Armin, Leong Natalie L, Wang Christopher, Buser Zorica, Wang Jeffrey C, Vezeridis Peter S, McAllister David R, Petrigliano Frank A
Orthopedics. 2018 May 1;41(3):e400-e409. doi: 10.3928/01477447-20180409-01. Epub 2018 Apr 16.
Outpatient arthroplasty is an appealing option among select patient populations as a mechanism for reducing health care expenditure. The purpose of this study was to determine the nationwide trends and complication profile of outpatient total shoulder arthroplasty (TSA). The authors reviewed a national administrative claims database to identify patients undergoing TSA as outpatients and inpatients from 2007 to 2016. The incidence of perioperative surgical and medical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes. Multivariate logistic regression adjusted for age, sex, and Charlson Comorbidity Index was used to calculate odds ratios of complications among outpatients relative to inpatients undergoing TSA. The query identified 1555 patients who underwent outpatient TSA and 15,987 patients who underwent inpatient TSA. The median age was in the 70 to 74 years age group in both the outpatient and the inpatient cohorts, and the age distribution was comparable between the 2 cohorts (P=.287). The incidence of both outpatient (P<.001) and inpatient (P<.001) TSA increased during the study period. On adjustment for age, sex, and comorbidities, patients undergoing outpatient TSA had significantly lower rates of stiffness requiring manipulation under anesthesia (outpatient, 1.09%; inpatient, 2.35%; odds ratio, 0.52; 95% confidence interval, 0.38-0.71; P<.001) and higher rates of postoperative surgical site infections requiring reoperation (outpatient, 0.90%; inpatient, 0.65%; odds ratio, 1.65; 95% confidence interval, 1.15-2.35; P<.001) at 1 year. Rates of all other postoperative complications were comparable. Ambulatory TSA is increasing in incidence nationwide and is associated with an overall favorable postoperative complication profile. [Orthopedics. 2018; 41(3):e400-e409.].
门诊关节置换术对于特定患者群体而言是一种颇具吸引力的选择，可作为降低医疗保健支出的一种手段。本研究的目的是确定全国范围内门诊全肩关节置换术（TSA）的趋势及并发症情况。作者回顾了一个全国性的行政索赔数据库，以识别2007年至2016年期间接受门诊和住院TSA的患者。通过查询相关的《国际疾病分类，第九版》和《当前程序术语》代码来确定围手术期手术和医疗并发症的发生率。使用针对年龄、性别和查尔森合并症指数进行调整的多变量逻辑回归来计算门诊患者与接受TSA的住院患者相比并发症的比值比。该查询确定了1555例接受门诊TSA的患者和15987例接受住院TSA的患者。门诊和住院队列的中位年龄均在70至74岁年龄组，且两个队列的年龄分布具有可比性（P = 0.287）。在研究期间，门诊（P < 0.001）和住院（P < 0.001）TSA的发生率均有所增加。在对年龄、性别和合并症进行调整后，接受门诊TSA的患者在1年时需要在麻醉下进行手法治疗的僵硬发生率显著较低（门诊，1.09%；住院，2.35%；比值比，0.52；95%置信区间，0.38 - 0.71；P < 0.001），而需要再次手术的术后手术部位感染发生率较高（门诊，0.90%；住院，0.65%；比值比，1.65；95%置信区间，1.15 - 2.35；P < 0.001）。所有其他术后并发症的发生率具有可比性。门诊TSA在全国范围内的发生率正在增加，且总体术后并发症情况良好。[《骨科》。2018年；41(3):e400 - e409。]
