Jansen Joris A, Kruidenier Jeroen, Spek Bea, Snoeker Barbara A M
Orthopedic Department, Alrijne Hospital, Leiden, the Netherlands.
Orthopedic Department, Alrijne Hospital, Leiden, the Netherlands.
Knee. 2020 Mar;27(2):451-458. doi: 10.1016/j.knee.2019.09.014. Epub 2020 Jan 22.
Since the introduction of arthroplasty fast-track protocols, many studies have investigated their effect on complications and length of hospital stay. However, few fast-track studies have examined the long-term effects on cost and health-related quality of life after total knee arthroplasty (TKA). This study aimed to specifically analyze, after implementation of fast-track TKA, cost-effectiveness with functional outcome, length of stay, thromboembolic complications, medical costs, and quality of life after 12 months.
A retrospective cohort of 403 TKA patients treated by a fast-track pathway were compared with 283 patients in a non-fast-track pathway. Length of stay and thromboembolic complications were registered postoperatively. Healthcare costs were based on hospital production costs and calculated on average. Costs were compared with EQ-5D questionnaires to derived quality-adjusted life year (QALY) scores.
No between-protocol differences were found in functional outcome and quality of life after TKA. The fast-track protocol reduced the length of stay from a median five days to median three days, and did not influence the thromboembolic complication rate (2.6%). After one-year follow-up for fast-track pathway patients, QALY was 0.85 vs. 0.84 for non-fast-track. A reduction of 268,- euro per patient was calculated in favor of the fast-track protocol.
Fast-track protocol implementation is a cost-effective strategy for patients undergoing TKA, with high QALY and reduced costs. Fast-track TKA treatment is safe, with low thromboembolic complications. This is the first study to measure fast-track implementation effects on functional outcome and quality of life up to 12 months postoperatively, and calculate equivalent QALYs for both groups.
Level III.
自关节置换快速康复方案引入以来，许多研究探讨了其对并发症和住院时间的影响。然而，很少有快速康复研究考察全膝关节置换术（TKA）后对成本及健康相关生活质量的长期影响。本研究旨在具体分析快速康复TKA实施后12个月时的成本效益，以及功能结局、住院时间、血栓栓塞并发症、医疗成本和生活质量。
将403例接受快速康复路径治疗的TKA患者的回顾性队列与283例接受非快速康复路径治疗的患者进行比较。术后记录住院时间和血栓栓塞并发症情况。医疗成本基于医院生产成本并进行平均计算。将成本与EQ-5D问卷进行比较以得出质量调整生命年（QALY）评分。
TKA后的功能结局和生活质量在不同方案之间未发现差异。快速康复方案将住院时间从中位数5天缩短至中位数3天，且未影响血栓栓塞并发症发生率（2.6%）。对快速康复路径患者进行一年随访后，快速康复组的QALY为0.85，非快速康复组为0.84。计算得出快速康复方案使每位患者成本降低268欧元。
快速康复方案的实施对接受TKA的患者而言是一种具有成本效益的策略，具有高QALY且成本降低。快速康复TKA治疗是安全的，血栓栓塞并发症发生率低。这是第一项测量快速康复实施对术后长达12个月的功能结局和生活质量的影响，并计算两组等效QALY的研究。
三级。
