全髋关节置换术在65岁及以上患者中优于半髋关节置换术：一项短期结局的倾向匹配研究。
Total Hip Arthroplasty Outperforms Hemiarthroplasty in Patients Aged 65 Years and Older: A Propensity-Matched Study of Short-Term Outcomes.
作者信息
Warren Jared A, Sundaram Kavin, Anis Hiba K, Piuzzi Nicolas S, Higuera Carlos A, Kamath Atul F
机构信息
Department of Orthopaedic Surgery, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA.
出版信息
Geriatr Orthop Surg Rehabil. 2019 Sep 20;10:2151459319876854. doi: 10.1177/2151459319876854. eCollection 2019.
INTRODUCTION
Displaced femoral neck fractures in the elderly individuals may be treated with total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). However, it is unclear what the short-term medical outcomes are related to these surgical options. The purpose of this study was to compare early postoperative outcomes in THA patients to those of HHA patients.
METHODS
In this study, we compared 30-day mortality, likelihood of still being in the hospital at 30 days, postoperative major and minor complications, discharge disposition, reoperation and readmission, length of stay, days from admission to surgery, and operative time between THA and HHA. Using the American College of Surgeons National Surgical Quality Improvement Project database, hip fracture patients ≥65 years old from 2008 to 2016 were identified. After propensity score matching, there were 2795 THAs and 2795 HHAs. To assess the effect of THA on the above-mentioned outcomes, bivariate regression models were created.
RESULTS
The THA patients ≥65 years old were at reduced risk for mortality ( = .029) and still being in the hospital at 30 days ( = .017). The THA patients were at an increased risk for minor complications ( = .011) and longer operative times ( < .001). However, THA patients were more likely to have a home discharge ( < .001).
DISCUSSION
Patients ≥65 years who underwent THA for hip fractures had reduced short-term mortality risk, were more likely to be discharged home, and had less likelihood of being in the hospital at 30 days. This is the first study to explore short-term outcomes in patients ≥65 and has direct implications for alternate payment and merit-based payment models.
CONCLUSION
As hip fracture treatment has come under scrutiny with respect to alternate payment models and merit-based incentive payments, this analysis of short-term outcomes warrants consideration when evaluating treatment pathways.
引言
老年患者的移位型股骨颈骨折可采用全髋关节置换术（THA）或半髋关节置换术（HHA）进行治疗。然而，目前尚不清楚这些手术方式的短期医疗结局如何。本研究的目的是比较THA患者与HHA患者的术后早期结局。
方法
在本研究中，我们比较了THA和HHA患者的30天死亡率、30天时仍住院的可能性、术后的主要和次要并发症、出院处置、再次手术和再入院情况、住院时间、入院至手术的天数以及手术时间。利用美国外科医师学会国家外科质量改进项目数据库，确定了2008年至2016年期间年龄≥65岁的髋部骨折患者。经过倾向得分匹配后，有2795例THA患者和2795例HHA患者。为评估THA对上述结局的影响，建立了双变量回归模型。
结果
年龄≥65岁的THA患者死亡风险降低（P = 0.029），30天时仍住院的可能性降低（P = 0.017）。THA患者发生次要并发症的风险增加（P = 0.011），手术时间更长（P < 0.001）。然而，THA患者更有可能在家中出院（P < 0.001）。
讨论
因髋部骨折接受THA治疗的年龄≥65岁患者短期死亡风险降低，更有可能在家中出院，且30天时住院的可能性较小。这是第一项探讨年龄≥65岁患者短期结局的研究，对替代支付和基于绩效的支付模式有直接影响。
结论
由于髋部骨折治疗在替代支付模式和基于绩效的激励支付方面受到审查，在评估治疗途径时，对短期结局的这一分析值得考虑。
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