Medicine Service, VA Medical Center , Birmingham, AL, USA.
Department of Medicine at School of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA.
Scand J Rheumatol. 2021 Jan;50(1):34-39. doi: 10.1080/03009742.2020.1760930. Epub 2020 Jul 15.
: To assess whether juvenile idiopathic arthritis (JIA) is associated with healthcare utilization and in-hospital complications after total hip or knee arthroplasty (THA/TKA). We used the 1998-2014 US National Inpatient Sample. We performed multivariable-adjusted logistic regression, adjusted for age, race/ethnicity, gender, income, Deyo-Charlson comorbidity index, insurance payer, and the underlying diagnosis. Of the 4 116 485 THAs and 8 127 282 TKAs, 1882 people with JIA had THAs (0.02%) and 1388 had TKAs (0.01%). Compared to people without JIA, people with JIA post-THA and post-TKA had higher odds ratio [OR (95% confidence interval), respectively] of total hospital charges above the median [1.30 (1.05, 1.60) and 1.37 (1.08, 1.74)], length of hospital stay > 3 days [1.64 (1.27, 2.12) and 1.44 (1.07, 1.93)], and discharge to non-home settings [1.37 (1.07, 1.76)] post-THA, but not post-TKA [1.02 (0.77, 1.36)]. People with JIA also had higher OR of transfusion post-TKA [1.92 (1.44, 2.55)], but not post-THA [1.00 (0.77, 1.30)]. Sensitivity analyses that adjusted for hospital characteristics confirmed the main study findings with minimal or no attenuation of OR. People with JIA utilized more healthcare services post-THA/TKA and were more likely to receive transfusions post-TKA. Interventions to reduce the risk of higher resource utilization are needed in people with JIA.
评估幼年特发性关节炎（JIA）是否与全髋关节或全膝关节置换术后的医疗保健利用和住院并发症相关。我们使用了 1998-2014 年美国国家住院患者样本。我们进行了多变量调整的逻辑回归，调整了年龄、种族/民族、性别、收入、Deyo-Charlson 合并症指数、保险支付者和基础诊断。在 4116485 例 THA 和 8127282 例 TKA 中，1882 例 JIA 患者行 THA（0.02%），1388 例行 TKA（0.01%）。与无 JIA 患者相比，JIA 患者行 THA 和 TKA 后总住院费用高于中位数的可能性更高[比值比（95%置信区间），分别为 1.30（1.05，1.60）和 1.37（1.08，1.74）]、住院时间>3 天[1.64（1.27，2.12）和 1.44（1.07，1.93）]、出院至非家庭环境[1.37（1.07，1.76）]行 THA 后，而非 TKA 后[1.02（0.77，1.36）]。JIA 患者行 TKA 后输血的比值比也更高[1.92（1.44，2.55）]，但行 THA 后则不然[1.00（0.77，1.30）]。调整医院特征的敏感性分析证实了主要研究结果，OR 值几乎没有或没有减弱。JIA 患者在 THA/TKA 后使用了更多的医疗保健服务，并且更有可能在 TKA 后接受输血。需要针对 JIA 患者采取干预措施，以降低资源利用增加的风险。
