Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia.
Department of Orthopedic Surgery, McLaren Flint Hospital, Flint, Michigan.
J Bone Joint Surg Am. 2018 Oct 17;100(20):1757-1764. doi: 10.2106/JBJS.18.00166.
The length of stay (LOS) in the hospital for total knee arthroplasty (TKA) has been declining over recent decades. The purpose of this study was to determine if patients with an LOS for TKA that includes only 1 midnight have an increased odds of 90-day readmission compared with those with a 2-midnight LOS. We also sought to identify any predictors of 90-day hospital readmission among those readmitted during our period of analysis.
A retrospective review of the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database was performed to identify patients with a 1-midnight or 2-midnight LOS for TKA during a 5-year period. The primary end point of this study was inpatient readmission within the 90-day postoperative period. A multiple logistic regression model and propensity score matching were used to compare the odds of 90-day readmission between 1-midnight and 2-midnight LOS. The secondary end points of this study were 90-day complications.
There were 96,250 TKA procedures identified in the database, and 46,709 met our inclusion criteria for LOS. No difference in 90-day-readmission odds between patients with a 1-midnight LOS and those with a 2-midnight LOS for primary TKA was identified. Male sex, single marital status, age of ≥80 years, type-I diabetes, previous smoking, narcotic use prior to surgery, and a higher American Society of Anesthesiologists (ASA) scores increased the odds of 90-day readmission. Patients in the age group of ≥50 to <65 years, those with a higher preoperative hemoglobin level, and those with a positive social history of alcohol use were found to have decreased odds of readmission.
We found no association between the LOS for primary TKA (1 midnight compared with 2 midnights) and the 90-day readmission risk.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
近年来，全膝关节置换术（TKA）的住院时间（LOS）一直在缩短。本研究旨在确定 TKA 住院时间仅为 1 个午夜的患者与 LOS 为 2 个午夜的患者相比，90 天再入院的几率是否增加。我们还试图确定在我们的分析期间被再入院的患者中，90 天内再入院的任何预测因素。
对密歇根关节置换登记协作质量倡议（MARCQI）数据库进行回顾性分析，以确定在 5 年内 TKA 住院时间为 1 个午夜或 2 个午夜的患者。本研究的主要终点是术后 90 天内的住院再入院。使用多因素逻辑回归模型和倾向评分匹配来比较 1 个午夜和 2 个午夜 LOS 的 90 天再入院几率。本研究的次要终点是 90 天内的并发症。
数据库中共有 96250 例 TKA 手术，符合 LOS 纳入标准的有 46709 例。在初次 TKA 中，LOS 为 1 个午夜的患者与 LOS 为 2 个午夜的患者的 90 天再入院几率无差异。男性、单身、年龄≥80 岁、1 型糖尿病、既往吸烟史、术前使用麻醉性镇痛药、ASA 评分较高均增加了 90 天再入院的几率。年龄在 50 至<65 岁、术前血红蛋白水平较高、有阳性饮酒史的患者，再入院的几率降低。
我们未发现初次 TKA 的 LOS（1 个午夜与 2 个午夜）与 90 天再入院风险之间存在关联。
治疗性 III 级。欲了解完整的证据等级说明，请参见作者须知。
