From the Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA (Dr. Arshi, Dr. SooHoo), the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Dr. Leong), the Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Dr. C. Wang, Dr. Buser, Dr. J. C. Wang).
J Am Acad Orthop Surg. 2019 Jan 15;27(2):61-67. doi: 10.5435/JAAOS-D-17-00210.
With healthcare expenditure in the national forefront, outpatient arthroplasty is an appealing option in select patient populations. The purpose of this study was to determine the complication rates associated with outpatient total hip arthroplasty (THA) in comparison to standard inpatient THA.
We performed a retrospective review of the Humana subset of the PearlDiver insurance records database to identify patients undergoing THA (Current Procedural Terminology-27130 and Current Procedural Terminology-27132) as either outpatients or inpatients from 2007 to 2016. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index were used to calculate odds ratios of complications among outpatients undergoing THA relative to inpatients undergoing THA.
The query identified 2,184 patients who underwent outpatient THA and 73,596 patients who underwent inpatient THA. The median age was in the 65 to 69 age group and in the 70 to 74 age group for the outpatient and inpatient cohorts, respectively (P < 0.001). Outpatients undergoing THA had a significantly lower incidence of comorbid hypertension (P < 0.001), cerebrovascular disease (P = 0.001), obesity (P = 0.017), chronic obstructive pulmonary disorder (P = 0.045), and chronic kidney disease (P = 0.049). The incidence of both outpatient THA (P = 0.001) and inpatient THA (P < 0.001) increased over the study period. After adjusting for age, gender, and Charlson Comorbidity Index, patients undergoing outpatient THA had comparable rates of all queried surgical complications, including component revision, irrigation and debridement, and hip dislocation at 1 year. Rates of postoperative medical complications were also comparable between the two cohorts.
Outpatient THA is increasing in frequency nationwide and has comparable postoperative complication rates. With its potential to minimize arthroplasty care costs, outpatient THA is a safe and effective option among appropriately selected patients.
随着医疗保健支出成为国家关注的焦点，门诊关节置换术成为某些患者群体中极具吸引力的选择。本研究旨在确定与标准住院全髋关节置换术（THA）相比，门诊全髋关节置换术（THA）相关的并发症发生率。
我们对 Humana 下属的 PearlDiver 保险记录数据库进行回顾性分析，以确定 2007 年至 2016 年期间接受 THA（手术操作分类-27130 和手术操作分类-27132）治疗的门诊或住院患者。采用多变量逻辑回归调整年龄、性别和 Charlson 合并症指数，计算门诊接受 THA 治疗的患者与住院接受 THA 治疗的患者发生并发症的比值比。
查询确定了 2184 例门诊接受 THA 治疗的患者和 73596 例住院接受 THA 治疗的患者。门诊和住院队列的中位年龄分别在 65 至 69 岁和 70 至 74 岁（P < 0.001）。门诊接受 THA 治疗的患者合并症中高血压（P < 0.001）、脑血管病（P = 0.001）、肥胖（P = 0.017）、慢性阻塞性肺疾病（P = 0.045）和慢性肾脏病（P = 0.049）的发生率显著较低。门诊（P = 0.001）和住院（P < 0.001）THA 的发生率均呈上升趋势。调整年龄、性别和 Charlson 合并症指数后，门诊接受 THA 治疗的患者在 1 年时所有手术并发症（包括翻修、灌洗和清创术以及髋关节脱位）的发生率相当。两组术后医疗并发症的发生率也相当。
全国范围内门诊 THA 的频率不断增加，且术后并发症发生率相当。由于其具有降低关节置换术成本的潜力，因此对于适当选择的患者而言，门诊 THA 是一种安全有效的选择。
