Qin Charles, Lee Cody, Ho Sherwin, Koh Jason, Athiviraham Aravind
University of Chicago Hospitals, Department of Orthopedic Surgery, Chicago, Il, 60637, USA.
Northshore University Health System, Evanston, Il, 60601, USA.
J Orthop. 2019 Dec 20;20:28-31. doi: 10.1016/j.jor.2019.12.009. eCollection 2020 Jul-Aug.
There has been an increase in the number of hip arthroscopy procedures performed in the outpatient setting. The purpose of this study was to query a national database to compare post-operative adverse events between hip arthroscopy procedures performed in hospital based outpatient departments (HOPD) versus ASC's. The Humana Claims Database was queried for all patients undergoing hip arthroscopy performed between 2007 and 2016, using the PearlDiver supercomputer. The study population was divided into two cohorts based on the surgical setting, ASC or HOPD. Complications of interest occurring within 90 days after surgery included Center for Medicare and Medicaid Services (CMS)-reportable complications, readmission, and return to the operating room. Visits to the emergency department after 7 days of surgery was also studied. Univariate comparisons between ASC and HOPD groups were drawn with chi-square tests for categorical variables and t-tests for continuous variables. Logistic regression models were created to determine the association between surgical setting and primary outcomes. Rates of 90-day CMS-reportable complications (2.95% vs 2.17%%; p = 0.193), 90-day readmission (4.95% vs 4.25%; p = 0.370) and return to the operating room within 90 days (0.07% vs 0.2%; p = 0.286) were not significantly different between groups. Rate of visits to the emergency department within 7 days was not statistically different between groups (2.57% vs 3.03%; p = 0.458). With the ASC group as reference, no statistically significant association between an outcome and surgical setting was detected after adjusting for confounding factors including comorbidity burden. These findings provide reassurance to providers who perform these procedures in either surgical setting.
门诊环境下进行的髋关节镜手术数量有所增加。本研究的目的是查询一个全国性数据库,以比较在医院门诊部门(HOPD)与门诊手术中心(ASC)进行的髋关节镜手术术后不良事件。使用PearlDiver超级计算机,查询了Humana理赔数据库中2007年至2016年期间接受髋关节镜手术的所有患者。根据手术环境将研究人群分为两个队列,即ASC或HOPD。术后90天内发生的感兴趣的并发症包括医疗保险和医疗补助服务中心(CMS)可报告的并发症、再入院和返回手术室。还研究了术后7天后到急诊科就诊的情况。对ASC组和HOPD组进行单变量比较,分类变量采用卡方检验,连续变量采用t检验。建立逻辑回归模型以确定手术环境与主要结局之间的关联。90天CMS可报告并发症发生率(2.95%对2.17%;p = 0.193)、90天再入院率(4.95%对4.25%;p = 0.370)和90天内返回手术室率(0.07%对0.2%;p = 0.286)在两组之间无显著差异。两组术后7天内到急诊科就诊率无统计学差异(2.57%对3.03%;p = 0.458)。以ASC组为参照,在调整包括合并症负担等混杂因素后,未发现结局与手术环境之间存在统计学显著关联。这些发现为在任何一种手术环境中进行这些手术的医护人员提供了安心的依据。