Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York.
Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, One Gustave L. Levy Place, New York, New York.
J Knee Surg. 2021 Aug;34(10):1110-1119. doi: 10.1055/s-0040-1701516. Epub 2020 Mar 4.
Given increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003-2016), we extracted data on total knee arthroplasty revisions ( = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300-499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran-Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% ( = 199,818) with a minor increasing trend: 25.3% ( = 7,828) in 2003 to 28.9% ( = 19,275) in 2016; < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003-$20,273 in 2016; < 0.0001) while median per-day costs slightly increased ($3,452 in 2003-$3,727 in 2016; < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003-30.7% in 2016; < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).
由于对初次膝关节置换术的需求不断增加，翻修手术预计也将增加，而假体周围关节感染（PJI）是导致成本增加的主要因素。目前缺乏关于全国趋势的最新数据。我们旨在评估全膝关节置换术翻修术和住院费用中 PJI 的趋势。从全国住院患者样本（2003-2016 年）中，我们提取了全膝关节置换术翻修术的数据（ = 782,449）。我们评估了所有翻修术的 PJI 患病率和（通胀调整后）住院费用（总费用和每日费用）的趋势，并按医院教学地位（农村/城市按教学地位）、医院床位数（≤299、300-499 和≥500 张）和医院区域（东北地区、中西部地区、南部地区和西部地区）进行分层。Cochran-Armitage 趋势检验（PJI 患病率）和线性回归确定了趋势的显著性。总体而言，PJI 患病率为 25.5%（ = 199,818），呈轻微上升趋势：2003 年为 25.3%（ = 7,828），2016 年为 28.9%（ = 19,275）； < 0.0001。PJI 的总住院费用中位数略有下降（2003 年为 23,247 美元，2016 年为 20,273 美元； < 0.0001），而每日费用中位数略有增加（2003 年为 3,452 美元，2016 年为 3,727 美元； < 0.0001），可能是由于住院时间缩短所致。由于医院之间的差异较小，最低和最高 PJI 患病率分别见于小医院（≤299 张床位；22.9%）和城市教学医院（27.3%）。在分层分析中，PJI 患病率呈上升趋势，特别是在较大的医院（≥500 张床位；2003 年为 24.4%，2016 年为 30.7%； < 0.0001），而在小医院中则呈下降趋势。总体而言，膝关节置换术翻修术中的 PJI 似乎略有增加。此外，大医院呈上升趋势，小医院呈下降趋势，表明患者从小医院向大医院转移。总费用呈下降趋势，每日费用呈上升趋势，这表明在过去几年中，住院时间趋势和 PJI 更有效的治疗方法（以较短的住院时间为指标）产生了强烈影响。
