From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith).
Can J Surg. 2020 Apr 17;63(2):E167-E173. doi: 10.1503/cjs.001019.
Patients with bilateral end-stage hip or knee arthritis want to know if it is safe to have bilateral surgery under a single anesthetic, to restore their quality of life as quickly as possible. The purpose of this study was to assess if there is an increase in the rate of postoperative medical adverse events, length of stay (LOS), blood transfusion rate and 30-day readmission rate among patients who undergo 1-stage bilateral total hip arthroplasty (BTHA) and 1-stage bilateral total knee arthroplasty (BTKA) compared with patients who undergo 2-stage BTHA and BTKA.
Our study cohorts included patients who underwent BTHA and BTKA between Apr. 1, 2009, and Jan. 31, 2016, in Alberta, Canada. To minimize selection bias associated with our retrospective study design, we matched patients who underwent 1-stage BTHA and BTKA with patients with patients who underwent 2-stage BTHA and BTKA, respectively, for age, sex and number of presurgical risk factors using propensity score in a matching ratio of 1:1.
Our study included 1645 patients who underwent BTHA and 4125 patients who underwent BTKA. We matched 195 patients who underwent 1-stage BTHA and 302 patients who underwent 1-stage BTKA with patients who underwent 2-stage BTHA and BTKA, respectively. There was no significant difference in postoperative medical adverse events between the 1-stage and 2-stage matched cohort groups for both BTHA (adjusted odds ratio [OR] 1.3, 95% confidence interval [CI] 0.3-4.9) and BTKA (adjusted OR 0.9, 95% CI 0.3-2.6). There was no difference in inpatient, 30- or 90-day mortality between the 2 groups for BTHA or BTKA. Patients who underwent 1-stage BTHA and BTKA had a shorter acute length of stay but increased total length of stay (acute care and rehabilitation unit) and were less likely to be discharged home postoperatively. One-stage BTHA and BTKA were associated with higher odds of blood transfusion than 2-stage BTHA and BTKA. The 30-day readmission rate was significantly lower for 1-stage BTHA than for the 2-stage BTHA matched cohort (adjusted OR 0.3, 95% CI 0.1-0.8), whereas there was no difference in the 30-day readmission rate (adjusted OR 0.6, 95% CI 0.2-1.7) between the 1-stage and 2-stage BTKA matched cohorts. Finally, operating room time was significantly lower for 1-stage BTHA (49.6 min less) and 1-stage BTKA (66.7 min less) than for the 2-stage arthroplasty procedures.
Healthy patients who undergo 1-stage BTHA and BTKA have postoperative medical complication rates comparable to those of patients who undergo 2-stage procedures with the additional benefits of a shorter acute length of stay, but they do have a higher risk of blood transfusion and are less likely to be discharged directly home from the acute care hospital. A multicentre randomized controlled trial on this topic is currently being condcuted by the Canadian Arthroplasty Society.
患有双侧终末期髋或膝关节关节炎的患者想知道在单次麻醉下进行双侧手术是否安全，以便尽快恢复生活质量。本研究的目的是评估与分期双侧全髋关节置换术（BTHA）和分期双侧全膝关节置换术（BTKA）相比，一期双侧全髋关节置换术（BTHA）和分期双侧全膝关节置换术（BTKA）的患者术后医疗不良事件发生率、住院时间（LOS）、输血率和 30 天再入院率是否增加。
我们的研究队列包括 2009 年 4 月 1 日至 2016 年 1 月 31 日期间在加拿大艾伯塔省接受 BTHA 和 BTKA 的患者。为了最大程度地减少我们回顾性研究设计相关的选择偏差，我们使用倾向评分将接受一期 BTHA 和 BTKA 的患者与分别接受二期 BTHA 和 BTKA 的患者按年龄、性别和术前危险因素数量进行匹配，匹配比例为 1:1。
我们的研究包括 1645 名接受 BTHA 的患者和 4125 名接受 BTKA 的患者。我们将 195 名接受一期 BTHA 的患者和 302 名接受一期 BTKA 的患者分别与接受二期 BTHA 和 BTKA 的患者进行匹配。一期和二期匹配队列中，BTHA（调整后比值比[OR]1.3，95%置信区间[CI]0.3-4.9）和 BTKA（调整后 OR 0.9，95%CI 0.3-2.6）的术后医疗不良事件发生率没有显著差异。BTHA 或 BTKA 患者在两组之间的住院、30 天或 90 天死亡率均无差异。接受一期 BTHA 和 BTKA 的患者急性住院时间较短，但总住院时间（急性护理和康复病房）较长，术后更不可能直接出院回家。与二期 BTHA 和 BTKA 相比，一期 BTHA 和 BTKA 输血的可能性更高。一期 BTHA 的 30 天再入院率明显低于二期 BTHA 匹配队列（调整后 OR 0.3，95%CI 0.1-0.8），而一期和二期 BTKA 匹配队列之间的 30 天再入院率（调整后 OR 0.6，95%CI 0.2-1.7）无差异。最后，一期 BTHA（少 49.6 分钟）和一期 BTKA（少 66.7 分钟）的手术室时间明显短于二期关节置换手术。
接受一期 BTHA 和 BTKA 的健康患者术后发生医疗并发症的几率与接受二期手术的患者相当，但具有较短的急性住院时间，而且输血风险更高，从急性护理医院直接出院的可能性更小。加拿大关节置换学会目前正在就这一主题进行一项多中心随机对照试验。
