Lindberg-Larsen M, Pitter F T, Husted H, Kehlet H, Jørgensen C C
The Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B. Winsløvsvej 4, 5000, Odense C, Denmark.
Arch Orthop Trauma Surg. 2019 May;139(5):709-716. doi: 10.1007/s00402-019-03157-z. Epub 2019 Mar 6.
Limited data exist on patient safety after simultaneous vs staged bilateral total knee arthroplasty (TKA) in matched groups. Hence, the aim of this study was to compare length of stay (LOS), in-hospital complications, 30-day readmissions and mortality after simultaneous and staged bilateral TKA in matched patients.
A retrospective case-control study of prospectively collected data in nine centres from February 2010 to November 2015. Propensity scores (PS) were used to match simultaneous and staged (1-6 months between stages) bilateral TKA patients with prospectively collected patient characteristics from the Lundbeck Foundation Centre for Fast-track THA and TKA Database. 30-day follow-up was acquired from the Danish Patient Registry and patient records.
A total of 344 (47.1%) simultaneous and 386 (52.9%) staged bilateral TKA procedures were performed. PS matching was possible in 232 simultaneous and 232 staged bilateral TKA patients. LOS was median 4 days (IQR 3-5) after simultaneous and cumulated 4 days (IQR 4-6) after staged procedures. The in-hospital complication rate was 15.5% after simultaneous vs 7.3% (p = 0.004) after staged procedures. Two cases (0.9%) of venous thromboembolic events were found in each group. Eight patients (3.4%) were re-operated after simultaneous vs one patient (0.4%) after staged bilateral TKA (p = 0.037). The 30-day readmission rate was 8.6% after simultaneous vs 5.6% after staged procedures (p = 0.281). No patients died in either group.
We found no significant differences in 30-day readmission rates and mortality between simultaneous and staged bilateral TKA, but the in-hospital complication rate and re-operation rate was higher after the simultaneous procedure calling for further matched investigations in larger cohorts.
关于配对组中同期与分期双侧全膝关节置换术（TKA）后患者安全性的数据有限。因此，本研究的目的是比较配对患者同期与分期双侧TKA后的住院时间（LOS）、院内并发症、30天再入院率和死亡率。
一项对2010年2月至2015年11月期间九个中心前瞻性收集的数据进行的回顾性病例对照研究。使用倾向评分（PS）将同期与分期（分期间隔1 - 6个月）双侧TKA患者与从伦贝克快速康复全髋关节置换术和全膝关节置换术数据库前瞻性收集的患者特征进行匹配。从丹麦患者登记处和患者记录中获取30天随访数据。
共进行了344例（47.1%）同期和386例（52.9%）分期双侧TKA手术。232例同期和232例分期双侧TKA患者实现了PS匹配。同期手术后LOS中位数为4天（IQR 3 - 5），分期手术后累计为4天（IQR 4 - 6）。同期手术后院内并发症发生率为15.5%，分期手术后为7.3%（p = 0.004）。每组均发现2例（0.9%）静脉血栓栓塞事件。同期双侧TKA后8例患者（3.4%）接受了再次手术，分期双侧TKA后1例患者（0.4%）接受了再次手术（p = 0.037）。同期手术后30天再入院率为8.6%，分期手术后为5.6%（p = 0.281）。两组均无患者死亡。
我们发现同期与分期双侧TKA在30天再入院率和死亡率方面无显著差异，但同期手术后院内并发症发生率和再次手术率较高，需要在更大队列中进行进一步的匹配研究。
