Dahlgren Nicholas, Lehtonen Eva, Anderson Matthew, Archie Adam T, McGwin Gerald, Shah Ashish, Naranje Sameer M
Orthopaedics, University of Alabama School of Medicine, Birmingham, USA.
Orthopaedics, University of Miami, Miller School of Medicine, Miami, USA.
Cureus. 2018 Nov 26;10(11):e3640. doi: 10.7759/cureus.3640.
Total knee arthroplasty (TKA) is the most common joint replacement surgery performed in the United States. Given the aging and increasingly comorbid patient populations undergoing these procedures, complication rates and the need for subsequent hospital readmission are only expected to rise. It is, therefore, crucial to investigate the risk factors leading to readmission in order to improve patient outcomes. The purpose of this study is to identify significant risk factors for readmission following revision TKA procedures.
Patients undergoing revision TKA were identified at our institution from 2006-2017. The primary outcome was hospital readmission after revision TKA. Patient demographics, comorbidities, and postoperative complications were recorded and compared between readmitted and non-readmitted patients.
Forty-five (26.2%) of the 171 cases were readmitted following revision TKA. The leading diagnoses at readmission varied from arthrofibrosis in 28.9% of patients, implant infection in 22.2% of patients, and implant failure in 20.0% of patients. Male gender was found to be a significant independent variable for readmission. This study also found that 51.1% of all readmitted patients continued to have complaints that required additional hospital readmissions. The average number of total readmissions was 2.1 per readmitted patient.
This study was successful in identifying variables associated with readmission following revision TKA, as well as presenting information regarding the diagnoses associated with readmission. Our data also showed that if a patient was readmitted after revision TKA, it was likely that they would be admitted again. Due to the increasing prevalence and cost of these procedures, further studies are needed to better understand the risk factors and comorbidities leading to readmission in order to improve the perioperative care of these patients.
全膝关节置换术(TKA)是美国最常见的关节置换手术。鉴于接受这些手术的患者群体日益老龄化且合并症越来越多,并发症发生率以及随后再次入院的需求预计只会上升。因此,调查导致再次入院的风险因素对于改善患者预后至关重要。本研究的目的是确定翻修TKA手术后再次入院的重要风险因素。
在我们机构中确定2006年至2017年接受翻修TKA的患者。主要结局是翻修TKA后的医院再次入院情况。记录患者的人口统计学特征、合并症和术后并发症,并在再次入院和未再次入院的患者之间进行比较。
171例病例中有45例(26.2%)在翻修TKA后再次入院。再次入院时的主要诊断各不相同,28.9%的患者为关节纤维化,22.2%的患者为植入物感染,20.0%的患者为植入物失败。发现男性是再次入院的一个重要独立变量。本研究还发现,所有再次入院患者中有51.1%仍有需要再次入院的主诉。每位再次入院患者的总再次入院平均次数为2.1次。
本研究成功确定了与翻修TKA后再次入院相关的变量,并提供了与再次入院相关的诊断信息。我们的数据还表明,如果患者在翻修TKA后再次入院,他们很可能会再次入院。由于这些手术的患病率和成本不断增加,需要进一步研究以更好地了解导致再次入院的风险因素和合并症,从而改善这些患者的围手术期护理。