Department of Orthopedic Surgery, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States of America.
Knee. 2020 Aug;27(4):1176-1181. doi: 10.1016/j.knee.2020.05.012. Epub 2020 Jun 25.
Increasing demand for total knee arthroplasties (TKA) has been targeted by legislation to minimize costs and maximize outcomes. Home discharges reduce costs, and it is important to determine patient variables associated with this discharge disposition. We explored non-modifiable and modifiable factors associated with non-home discharges to determine what patient specific factors require attention.
This retrospective study included 171,903 National Surgical Quality Improvement Program (NSQIP) patients between 2011 and 2016. Patient specific variables and discharge destinations included home, short-term nursing facilities (SNF), not home, and rehabilitation. Chi-squared analyses and analyses of variance (ANOVA) were conducted for categorical and continuous data, respectively. Multinomial regression model was utilized to assess associations between discharge destination and patient specific variables.
Every year increase above the mean age (66 years) was associated with a nine percent (p < .001) and six percent (p < .001) increased odds for discharge to SNF or rehabilitation, respectively, compared to home discharges. Every 10% increase in BMI from the mean was associated with a 10% increase in discharge to both SNF and rehabilitation (p < .001 for both).
With increasing demands for TKAs and expenditures to Medicare, evaluating factors that impact patient discharge can help optimize costs and outcomes of TKA procedures. Arthroplasty surgeons can benefit by recognizing these correlations and exploring reductions to non-home discharges through pre-operative patient optimization. Future studies should evaluate the economic cost potential associated with optimizing routine home discharge in TKA patients.
IV.
为了降低成本和提高效果，立法要求增加全膝关节置换术（TKA）的数量。出院回家可以降低成本，因此确定与这种出院安排相关的患者变量非常重要。我们探讨了与非家庭出院相关的不可改变和可改变因素，以确定哪些患者特定因素需要注意。
本回顾性研究纳入了 2011 年至 2016 年期间的 171903 例国家手术质量改进计划（NSQIP）患者。患者特定变量和出院地点包括家庭、短期护理机构（SNF）、非家庭和康复。分别对分类数据和连续数据进行卡方分析和方差分析。利用多项回归模型评估出院地点与患者特定变量之间的关系。
每年的平均年龄（66 岁）增加一岁，与 SNF 或康复出院的几率分别增加 9%（p<0.001）和 6%（p<0.001），而家庭出院的几率则相应降低。与平均 BMI 相比，每增加 10%的 BMI，与 SNF 和康复出院的几率分别增加 10%（p<0.001）。
随着 TKA 需求的增加和 Medicare 支出的增加，评估影响患者出院的因素有助于优化 TKA 手术的成本和效果。关节置换外科医生可以通过认识到这些相关性，并通过术前患者优化来探索减少非家庭出院的方法从中受益。未来的研究应该评估在 TKA 患者中优化常规家庭出院的潜在经济成本。
IV。
