From the Tufts University School of Medicine (Mr. Pierce), the Department of Orthopedic Surgery, Tufts Medical Center (Dr. Menendez and Dr. Salzler), and the Department of Public Health and Community Medicine, Tufts University School of Medicine (Dr. Tybor), Boston, MA.
J Am Acad Orthop Surg. 2019 Jun 15;27(12):e568-e576. doi: 10.5435/JAAOS-D-17-00789.
National databases are increasingly used to research complication rates, risk factors, and the role of comorbidities. Three commonly used databases are the Healthcare Cost and Utilization Program's National Inpatient Sample (NIS), the National Hospital Discharge Survey (NHDS), and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Despite many publications, the accuracy of results from these databases remains unclear.
We compared demographics and complication rates of primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA) across three national databases from 2006 to 2010. Using International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes to identify cases, we calculated postoperative inpatient complication rates in all three databases and 30-day complication rates in the NSQIP.
We identified a total of 607,322 TKAs and 279,428 THAs. Overall complication rates varied greatly between the databases. For TKA, the overall complication rates were the highest in the NIS (17.3% [16.6 to 18.0]), followed by the NHDS (14.9% [14.0 to 15.8]), and then the NSQIP 30 days (10.20% [9.73 to 10.70]) and the NSQIP until discharge (7.34% [6.95 to 7.75]). Similarly, for THA, the NIS was the highest (24.09% [23.05 to 25.16]), and then the NHDS (21.5% [19.8 to 23.2]), followed by the NSQIP 30 days (12.00% [11.31 to 12.72]), and the NSQIP until discharge (9.25% [8.64 to 9.90]). Breakdown and comparison of individual adverse events further revealed different complication rates.
The estimated complication rates from THA and TKA depend on which data source is used because of differences in data collection and sampling methodology. Similar differences may exist in other publications that use such secondary data sources.
国家数据库越来越多地被用于研究并发症发生率、风险因素以及合并症的作用。三个常用的数据库是医疗保健成本和利用项目的国家住院患者样本（NIS）、国家住院患者调查（NHDS）和美国外科医师学会国家外科质量改进计划（NSQIP）。尽管有许多出版物，但这些数据库的结果准确性仍不清楚。
我们比较了 2006 年至 2010 年三个国家数据库中初次全髋关节置换术（THA）和初次全膝关节置换术（TKA）的人口统计学和并发症发生率。使用国际疾病分类，第九修订版，临床修正和当前程序术语代码来识别病例，我们计算了所有三个数据库中的术后住院并发症发生率和 NSQIP 的 30 天并发症发生率。
我们共确定了 607322 例 TKA 和 279428 例 THA。总体并发症发生率在数据库之间差异很大。对于 TKA，NIS 的总体并发症发生率最高（17.3%[16.6 至 18.0]），其次是 NHDS（14.9%[14.0 至 15.8]），然后是 NSQIP 30 天（10.20%[9.73 至 10.70]）和 NSQIP 直至出院（7.34%[6.95 至 7.75]）。同样，对于 THA，NIS 的发生率最高（24.09%[23.05 至 25.16%]），其次是 NHDS（21.5%[19.8 至 23.2%]），然后是 NSQIP 30 天（12.00%[11.31 至 12.72%]），最后是 NSQIP 直至出院（9.25%[8.64 至 9.90%]）。对个别不良事件的细分和比较进一步显示了不同的并发症发生率。
由于数据收集和抽样方法的不同，THA 和 TKA 的估计并发症发生率取决于所使用的数据源。其他使用此类二级数据源的出版物也可能存在类似的差异。
