Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
Philadelphia College of Osteopathic Medicine Ringgold Standard Institution, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania.
J Knee Surg. 2022 Feb;35(3):288-293. doi: 10.1055/s-0040-1713734. Epub 2020 Jul 13.
Same-day bilateral total knee arthroplasties (BTKAs) are associated with increased complications compared with staged procedures; however, as complication rates and lengths of stay (LOS) for same-day procedures decrease, they may become attractive alternatives to staged procedures. The void of recent nationwide studies comparing the 30-day total cost and risks of these procedures inspired this propensity matched review. Therefore, we compared 30-day outcomes in staged and same-day BTKAs occurring in 2016 and 2017 using the National Readmission Database (NRD), a nationwide database. The NRD was queried for all same-day and staged BTKA patients from January 1 to November 30 for both 2016 and 2017. Since the NRD links readmissions within one calendar year, TKAs occurring in this month were excluded to allow 30-day follow-up. Propensity matching was performed based on demographics, producing 19,334 patients in both cohorts. Thirty-day readmission, revision, and mortality rates, hospital costs, LOS, discharge dispositions, and complications were analyzed. Chi-square and Student's -tests assessed categorical and continuous variables, respectively. A -value of <0.05 was set as the threshold for statistical significance. The analysis demonstrated that less same-day patients were readmitted, with statistical but not clinical difference in revisions, and mortality (all < 0.050). Higher 30-day cost ($33,522 vs. $29,053, < 0.001), decreased total LOS (4.52 vs. 4.94 days, < 0.001), and lower rates of PEs (0.3 vs. 1.1%, < 0.001) and transfusions (2.1 vs. 8.5%, < 0.001) but similar total complications ( >0.050) were associated staged compared with same-day BTKAs. The results suggest inpatient cost savings associated with same-day surgeries should be weighed against the slight increase in LOS and PEs. Ultimately, as LOS and PE rates continue to decrease from innovations and quality improvements, same-day BTKA may become an attractive alternative to staged BTKAs, especially if payer's incentive surgeons by increasing physician reimbursements.
同期双侧全膝关节置换术 (BTKA) 与分期手术相比，并发症发生率更高; 然而，随着同期手术的并发症发生率和住院时间 (LOS) 的降低，它们可能成为分期手术的替代选择。由于缺乏最近比较这些手术 30 天总费用和风险的全国性研究，因此激发了这项倾向匹配回顾性研究。因此，我们使用全国再入院数据库 (NRD) 比较了 2016 年和 2017 年同期和分期 BTKA 的 30 天结果，NRD 是一个全国性数据库。对 2016 年和 2017 年 1 月 1 日至 11 月 30 日期间所有同期和分期 BTKA 患者进行了 NRD 检索。由于 NRD 链接了一年内的再入院情况，因此排除了本月内进行的 TKA，以便进行 30 天随访。基于人口统计学因素进行了倾向匹配，两组均产生了 19334 名患者。分析了 30 天再入院、翻修和死亡率、医院费用、住院时间、出院情况和并发症。卡方检验和学生 t 检验分别评估了分类变量和连续变量。设定 为 0.05 作为统计学显著性的阈值。分析表明，同期手术患者的再入院率较低，翻修和死亡率存在统计学差异，但无临床意义（均 <0.050）。同期手术患者的 30 天医疗费用更高（33522 美元 vs. 29053 美元，<0.001），总 LOS 更短（4.52 天 vs. 4.94 天，<0.001），PE 发生率更低（0.3% vs. 1.1%，<0.001）和输血率（2.1% vs. 8.5%，<0.001），但总并发症发生率相似（>0.050）。与同期 BTKA 相比，分期 BTKA 具有更高的 30 天成本（<0.001）、更长的总 LOS（<0.001）和更高的 PEs（<0.001）和输血率（<0.001）。结果表明，同期手术相关的住院费用节省应权衡 LOS 和 PEs 略有增加的风险。最终，随着创新和质量改进使 LOS 和 PE 持续降低，同期 BTKA 可能成为分期 BTKA 的替代选择，特别是如果支付方通过增加医生的补偿来激励医生。
