Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.
J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(2):2309499020918170. doi: 10.1177/2309499020918170.
Bilateral total knee arthroplasty (TKA) can be performed in patients with bilateral knee arthritis. Outside of nationwide database studies, which have limitations, few studies have compared outcomes for same-day versus staged TKA. We sought to compare patient outcomes at a single tertiary referral center.
The institutional database was queried from March 2014 to December 2017 for primary TKA. Patients undergoing bilateral procedures were stratified by same-day versus staged; length of stay (LOS), disposition, 90-day emergency department (ED) visits, and 90-day readmissions were examined through univariable and multivariable analyses.
A total of 676 patients were evaluated (113 same-day and 563 staged bilateral TKA patients) with mean age 66.0 (8.5) at first surgery and 292.1 (241.6) days between staged procedures. Same-day bilateral TKA patients were younger ( < 0.001), had lower body mass index (BMI) ( = 0.010), and had lower American Society of Anesthesiologists (ASA) scores ( = 0.030). They were more likely to have a prolonged LOS ( < 0.001) and be discharged to skilled nursing facility or rehab facility ( < 0.001). Total LOS for separate hospitalizations in staged procedures was greater than LOS for same-day bilateral TKAs ( < 0.001). There was no difference in 90-day ED visits ( = 0.623) or readmission ( = 0.286). In a multivariable model controlling for age, BMI, and ASA score, same-day bilateral TKA was not significantly associated with ED visits or readmissions.
Patients undergoing same-day bilateral TKAs were more likely to be discharged to post-acute care facilities, however they did not have increased 90-day readmissions.
双侧全膝关节置换术（TKA）可用于双侧膝关节关节炎患者。除了具有局限性的全国性数据库研究外，很少有研究比较过同一天与分期 TKA 的结果。我们旨在比较单一三级转诊中心的患者结果。
从 2014 年 3 月至 2017 年 12 月，我们对机构数据库进行了查询，以寻找初次 TKA 的患者。通过单变量和多变量分析，对同一天与分期进行双侧手术的患者进行分层，检查住院时间（LOS）、处置、90 天急诊部（ED）就诊和 90 天再入院情况。
共评估了 676 例患者（113 例同一天双侧 TKA 患者和 563 例分期双侧 TKA 患者），第一次手术的平均年龄为 66.0（8.5）岁，分期手术之间的间隔为 292.1（241.6）天。同一天双侧 TKA 患者更年轻（<0.001），体重指数（BMI）更低（=0.010），美国麻醉医师协会（ASA）评分也更低（=0.030）。他们更有可能出现较长的 LOS（<0.001），并被送往熟练护理机构或康复机构（<0.001）。分期手术的单独住院总 LOS 大于同一天双侧 TKA 的 LOS（<0.001）。90 天 ED 就诊（=0.623）或再入院（=0.286）无差异。在控制年龄、BMI 和 ASA 评分的多变量模型中，同一天双侧 TKA 与 ED 就诊或再入院无显著相关性。
同一天行双侧 TKA 的患者更有可能被送往急性后护理机构，但他们 90 天内的再入院率并没有增加。
