Departments of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA.
Reg Anesth Pain Med. 2019 Sep;44(9):854-859. doi: 10.1136/rapm-2019-100678. Epub 2019 Jul 11.
Arthroplasty is one of the most commonly performed procedures in the USA with projections of continuous growth. As this field undergoes continuous changes, the goal of this study was to provide an analysis of patient-related and healthcare system-related trends. This is important as it allows practitioners, administrators and policy makers to allocate needed resources appropriately.
The study included total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures from 2006 to 2016. Demographic information, comorbidities and complications were extracted and analyzed from the Premier Healthcare database.
The surgical volume increased annually over the observation period by an average of 5.54% for TKA and 7.02% for THA, respectively. The average age of the patient population and the types of anesthesia used remained relatively consistent over time. Comorbidity burden increased, especially for obesity (16.52% in 2006 and 29.77% in 2016 for TKA, 11.15% in 2006 and 20.92% in 2016 for THA), obstructive sleep apnea (OSA) (6.82% in 2006 and 17.03% in 2016 for TKA, 4.69% in 2006 and 12.72% in 2016 for THA) and renal insufficiency (2.81% in 2006 and 7.01% in 2016 for TKA, 2.78% in 2006 and 6.43% in 2016 for THA). Minor trends of increases were also observed in the prevalence of liver disease, depression and hypothyroidism. All postoperative complications were trending lower except for acute renal failure, where an increase was noted (4.39% in 2006 and 8.10% in 2016 for TKA, 4.99% in 2006 and 8.42% in 2016 for THA).
Significant trends in the care of patients who undergo TKA and THA were identified. Individuals undergoing these procedures presented with a higher prevalence of comorbidities. Despite these trajectories, complications declined over time. These data can be used to inform future research and to allocate resources to address changes in populations cared for and complications encountered.
关节置换术是美国最常见的手术之一，预计其数量将持续增长。随着该领域的不断发展，本研究旨在分析与患者和医疗保健系统相关的趋势。这一点很重要，因为它使从业者、管理人员和政策制定者能够适当地分配所需资源。
本研究纳入了 2006 年至 2016 年期间的全膝关节置换术（TKA）和全髋关节置换术（THA）。从 Premier Healthcare 数据库中提取并分析了人口统计学信息、合并症和并发症。
在观察期间，TKA 和 THA 的手术量平均每年分别以 5.54%和 7.02%的速度增长。患者人群的平均年龄和使用的麻醉类型随时间相对保持一致。合并症负担增加，尤其是肥胖症（TKA 分别从 2006 年的 16.52%增加到 2016 年的 29.77%，THA 分别从 2006 年的 11.15%增加到 2016 年的 20.92%）、阻塞性睡眠呼吸暂停（OSA）（TKA 分别从 2006 年的 6.82%增加到 2016 年的 17.03%，THA 分别从 2006 年的 4.69%增加到 2016 年的 12.72%）和肾功能不全（TKA 分别从 2006 年的 2.81%增加到 2016 年的 7.01%，THA 分别从 2006 年的 2.78%增加到 2016 年的 6.43%）。还观察到肝脏疾病、抑郁症和甲状腺功能减退症的患病率也呈轻微上升趋势。除急性肾衰竭外，所有术后并发症均呈下降趋势（TKA 分别从 2006 年的 4.39%下降到 2016 年的 3.62%，THA 分别从 2006 年的 4.99%下降到 2016 年的 4.26%）。
本研究确定了 TKA 和 THA 患者治疗中显著的趋势。接受这些手术的患者合并症患病率更高。尽管存在这些趋势，但并发症随时间呈下降趋势。这些数据可用于指导未来的研究，并分配资源以应对所照顾人群的变化和遇到的并发症。
