From the Ascension Providence Rochester Hospital (Dr. Frisch), Rochester, MI, the Rothman Institute and Thomas Jefferson University Hospital, (Dr. Courtney), Philadelphia, PA, the Henry Ford Hospital (Darrith), Detroit, MI, the VA Central Western Massachusetts Health System (Dr. Copeland), Leeds, MA, and the Department of Orthopaedic Surgery, Rush University Medical Center (Dr. Gerlinger), Chicago, IL.
J Am Acad Orthop Surg. 2020 Nov 15;28(22):923-929. doi: 10.5435/JAAOS-D-19-00775.
The Veterans Affairs (VA) health system is vital to providing joint replacement care to our retired service members but has come under recent scrutiny. The purpose of this study was to compare the short-term outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA) between the VA cohort and the general cohort.
We retrospectively reviewed 10.460 patients with primary THA and TKA from the Veterans Affairs Corporate Data Warehouse. As a control group, we queried the American College of Surgeons-National Surgical Quality Improvement Program database and identified 58,820 patients with primary THA and TKA over the same time period. We compared length of stay, mortality rates, 30-day complication rates, and 30-day readmissions. We performed a multivariate logistic regression analysis to identify the independent effect of the VA system on adverse outcomes.
Veterans are more likely to be men (93% versus 41%, P < 0.001) and have increased rates of medical comorbidities (all P < 0.001). The rate of short-term complications (all P < 0.001) were all higher in the VA cohort. When controlling for demographics and medical comorbidities, VA patients were more likely to have a readmission (P < 0.001), prolonged length of stay > 4 days (P < 0.001), and experience a complication within 30 days (P < 0.001).
Despite controlling for higher rates of medical comorbidities, VA patients undergoing primary THA and TKA had poorer short-term outcomes than the civilian cohort. Additional research is needed to ensure our veteran cohort is appropriately optimized and address the discrepancy with the outcomes of the civilian.
退伍军人事务部 (VA) 卫生系统对于为我们的退休军人提供关节置换护理至关重要，但最近受到了严格审查。本研究的目的是比较退伍军人事务部队列和普通队列接受全髋关节置换术 (THA) 和全膝关节置换术 (TKA) 后的短期结果。
我们回顾性分析了退伍军人事务部企业数据仓库中的 10460 例初次 THA 和 TKA 患者。作为对照组，我们查询了美国外科医师学会-国家外科质量改进计划数据库，并在同一时期确定了 58820 例初次 THA 和 TKA 患者。我们比较了住院时间、死亡率、30 天并发症发生率和 30 天再入院率。我们进行了多变量逻辑回归分析，以确定 VA 系统对不良结局的独立影响。
退伍军人更可能是男性 (93%对 41%，P < 0.001)，且患有更多的合并症 (均 P < 0.001)。退伍军人队列的短期并发症发生率均较高 (均 P < 0.001)。在控制人口统计学和合并症后，退伍军人更有可能再次入院 (P < 0.001)、住院时间延长 > 4 天 (P < 0.001)，且在 30 天内发生并发症 (P < 0.001)。
尽管控制了更高的合并症发生率，但接受初次 THA 和 TKA 的退伍军人的短期结果比平民队列差。需要进一步研究以确保我们的退伍军人队列得到适当优化，并解决与平民结果之间的差异。
