Richardson Shawn S, Kahlenberg Cynthia A, Blevins Jason L, Goodman Susan M, Sculco Thomas P, Figgie Mark P, Sculco Peter K
Hospital for Special Surgery, New York, NY, USA.
Hospital for Special Surgery, New York, NY, USA.
Knee. 2019 Oct;26(5):1096-1101. doi: 10.1016/j.knee.2019.06.008. Epub 2019 Jun 28.
Benefits of simultaneous bilateral total knee replacement (TKR) include lower costs, decreased hospital stay, and shorter rehabilitation. This study evaluated complications associated with simultaneous versus staged bilateral TKR within 12 months. We hypothesized that after controlling for comorbidities, the simultaneous group would have the highest rate of complications.
This retrospective study analyzed the Humana subset of the PearlDiver Patient Records Database. CPT 27447 and associated modifiers were used to identify patients who underwent simultaneous or staged bilateral primary TKRs. Staged bilateral TKRs were performed within 12 months and were stratified by the time between procedures. Primary outcomes were the Centers for Medicare & Medicaid Services' publicly reported complications. Risks of complications were compared using multivariate logistic regression controlling for age, gender, and comorbidities.
Seven thousand seven hundred forty-seven patients underwent simultaneous or staged bilateral TKRs between January 2007 and April 2015. There were lower odds of transfusion and all-cause 90-day readmission but higher odds of mechanical complications and infection for all staged groups compared to the simultaneous. Patients whose staged surgeries were ≪3 months apart had significantly higher odds of undergoing manipulation under anesthesia (MUA).
Higher rates of blood transfusion and readmission were associated with simultaneous bilateral TKR, while higher rates of mechanical complications and infection were associated with staged bilateral TKR. MUA risk was highest in patients staged ≪3 months apart. While there are inherent risks to simultaneous bilateral TKR, surgeons and patients should also be aware of risks associated with staging the procedures.
III.
同期双侧全膝关节置换术（TKR）的益处包括成本降低、住院时间缩短和康复时间缩短。本研究评估了12个月内同期与分期双侧TKR相关的并发症。我们假设在控制合并症后，同期组的并发症发生率最高。
这项回顾性研究分析了PearlDiver患者记录数据库中的Humana子集。使用CPT 27447及相关修饰符来识别接受同期或分期双侧初次TKR的患者。分期双侧TKR在12个月内进行，并按手术间隔时间分层。主要结局是医疗保险和医疗补助服务中心公开报告的并发症。使用多因素逻辑回归比较并发症风险，控制年龄、性别和合并症。
2007年1月至2015年4月期间，7747例患者接受了同期或分期双侧TKR。与同期组相比，所有分期组的输血和90天全因再入院几率较低，但机械并发症和感染几率较高。分期手术间隔时间≪3个月的患者接受麻醉下手法操作（MUA）的几率显著更高。
同期双侧TKR与较高的输血和再入院率相关，而分期双侧TKR与较高的机械并发症和感染率相关。分期间隔≪3个月的患者MUA风险最高。虽然同期双侧TKR存在固有风险，但外科医生和患者也应意识到分期手术相关的风险。
III级。
