Gwam Chukwuweike, Rosas Samuel, Sullivan Rashad, Luo T David, Emory Cynthia L, Plate Johannes F
Department of Orthopedic Surgery, Wake Forest University School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
Department of Orthopedics, Duke University School of Medicine, Durham, North Carolina.
J Knee Surg. 2020 Apr;33(4):378-386. doi: 10.1055/s-0039-1677857. Epub 2019 Feb 15.
The aim of this study was to assess (1) temporal trends, (2) primary indication, (3) patient-level demographics (age, race, gender, health status, and median income quartile), and (4) region and hospital type for all patients receiving primary total knee arthroplasty (TKA) between 2009 and the third quarter of 2015. The National Inpatient Sample Database (NIS) was used to identify all patients who underwent a TKA between 2009 and the third quarter of 2015. Regression analysis was utilized to assess trends. Chi-square analysis was used to explore categorical variables whereas Kruskal-Wallis test was used to explore nonparametric continuous variables. TKA utilization increased between 2009 and 2015 with the highest volume occurring during the fall. Primary osteoarthritis was the primary indication in 98% of cases. There was an increase in minority representation among recipients. Black TKA recipients were younger and had lower median age-adjusted Charlson's comorbidity index (CCI). Black recipients were most likely to be of the lowest 25% of median income than any other races. The Midwest demonstrated the greatest increase in TKAs performed per 100,000 between 2009 and 2014. Case volumes shifted to urban teaching hospitals between 2009 and 2014. There were differences in age of presentation, preoperative morbidity, and income status among races. Furthermore, our findings revealed a more rapid growth in TKA procedures per 100,000 in the Midwest, in addition to volume shifts toward urban teaching hospitals. Future studies are needed to update our findings as well as explore trends in racial disparities for primary TKA recipients.
本研究的目的是评估2009年至2015年第三季度期间接受初次全膝关节置换术（TKA）的所有患者的（1）时间趋势、（2）主要适应症、（3）患者层面的人口统计学特征（年龄、种族、性别、健康状况和收入中位数四分位数）以及（4）地区和医院类型。使用国家住院样本数据库（NIS）来识别2009年至2015年第三季度期间接受TKA的所有患者。采用回归分析评估趋势。使用卡方分析探索分类变量，而使用克鲁斯卡尔 - 沃利斯检验探索非参数连续变量。2009年至2015年期间TKA的使用量有所增加，秋季的使用量最高。原发性骨关节炎是98%病例的主要适应症。接受者中的少数族裔比例有所增加。黑人TKA接受者更年轻，年龄调整后的查尔森合并症指数（CCI）中位数更低。与其他任何种族相比，黑人接受者最有可能处于收入中位数最低的25%。2009年至2014年期间，中西部地区每10万人中进行的TKA手术增加最多。2009年至2014年期间，病例数量转向城市教学医院。不同种族在就诊年龄、术前发病率和收入状况方面存在差异。此外，我们的研究结果显示，中西部地区每10万人中TKA手术的增长更为迅速，同时病例数量也向城市教学医院转移。未来需要进行研究以更新我们的研究结果，并探索初次TKA接受者种族差异的趋势。
