人工关节周围股骨骨折的人口统计学、治疗方法及费用：内固定与翻修术对比
Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision.
作者信息
Ragland Katelyn, Reif Rebecca, Karim Saleema, Sexton Kevin W, Cherney Steven M, Stambough Jeffrey B, Mears Simon C
机构信息
Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Health Policy and Management, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
出版信息
Geriatr Orthop Surg Rehabil. 2020 Jul 19;11:2151459320939550. doi: 10.1177/2151459320939550. eCollection 2020.
INTRODUCTION
Periprosthetic femur fractures (PPFX) are complications of both total hip and knee arthroplasty and may be treated with open reduction and internal fixation (ORIF) or revision arthroplasty. Differences in treatment and fracture location may be related to patient demographics and lead to differences in cost. Our study examined the effects of demographics and treatment of knee and hip PPFXs on length of stay (LOS) and cost.
METHODS
Of all, 932 patients were identified with hip or knee PPFXs in the National Inpatient Sample from January 2013 to September 2015. Age, gender, race, mortality, comorbidity level, LOS, total cost, procedure type, geographic region, and hospital type were recorded. A generalized linear regression model was conducted to analyze the effect of fracture type on LOS and cost.
RESULTS
Differences in gender (66% vs 83.7% female, < .01), comorbidities (fewer in hips, < .01), and costs (US$30 979 vs US$27 944, < .01) were found between the hip and knee groups. Knees had significantly higher rates of ORIF treatment (80.7% vs 39.1%) and lower rates of revision arthroplasties (19.3% vs 60.9%) than hip PPFXs ( < .01). Within both groups, patients with more comorbidities, revision surgery, and blood transfusions were more likely to have a longer LOS and higher cost.
CONCLUSION
Periprosthetic femur fractures patients are not homogenous and treatment varies between hip and knee locations. For knee patients, those treated with ORIF were younger, with fewer comorbidities than those treated with revision. Conversely, hip patients treated with ORIF were older, with more comorbidities than those treated with revision. Hips had higher costs than knees, and cost correlated with revision arthroplasty and more comorbidities. In both hip and knee groups, longer LOS was associated with more comorbidities and being treated in urban teaching hospitals. Total cost had the strongest associations with revision procedures as well as number of comorbidities and blood product use.
引言
人工关节周围股骨骨折（PPFX）是全髋关节置换术和全膝关节置换术的并发症，可采用切开复位内固定术（ORIF）或关节置换翻修术进行治疗。治疗方式和骨折部位的差异可能与患者人口统计学特征有关，并导致费用差异。我们的研究探讨了膝关节和髋关节PPFX的人口统计学特征及治疗方法对住院时间（LOS）和费用的影响。
方法
在2013年1月至2015年9月的全国住院患者样本中，共识别出932例髋关节或膝关节PPFX患者。记录患者的年龄、性别、种族、死亡率、合并症水平、住院时间、总费用、手术类型、地理区域和医院类型。采用广义线性回归模型分析骨折类型对住院时间和费用的影响。
结果
髋关节组和膝关节组在性别（女性分别为66%和83.7%，P<0.01）、合并症（髋关节合并症较少，P<0.01）和费用（30979美元对27944美元，P<0.01）方面存在差异。与髋关节PPFX相比，膝关节采用ORIF治疗的比例显著更高（80.7%对39.1%），关节置换翻修术的比例更低（19.3%对60.9%）（P<0.01）。在两组中，合并症更多、接受翻修手术和输血的患者住院时间更长、费用更高的可能性更大。
结论
人工关节周围股骨骨折患者并非同质化群体，髋关节和膝关节部位的治疗方式有所不同。对于膝关节患者，接受ORIF治疗的患者比接受翻修术的患者更年轻，合并症更少。相反，接受ORIF治疗的髋关节患者比接受翻修术的患者年龄更大，合并症更多。髋关节的费用高于膝关节，费用与关节置换翻修术及更多合并症相关。在髋关节组和膝关节组中，住院时间延长均与更多合并症以及在城市教学医院接受治疗有关。总费用与翻修手术、合并症数量及血液制品使用的关联最为密切。
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