University of Oxford, Oxford, UK.
University of Oxford, Oxford, and National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, Hemel Hempstead, UK.
Arthritis Care Res (Hoboken). 2022 Mar;74(3):392-402. doi: 10.1002/acr.24470. Epub 2022 Jan 13.
To estimate the costs of primary hip and knee replacement in individuals with osteoarthritis up to 2 years postsurgery, compare costs before and after the surgery, and identify predictors of hospital costs.
Patients age ≥18 years with primary planned hip or knee replacements and osteoarthritis in England between 2008 and 2016 were identified from the National Joint Registry and linked with Hospital Episode Statistics data containing inpatient episodes. Primary care data linked with hospital outpatient records were also used to identify patients age ≥18 years with primary hip or knee replacements between 2008 and 2016. All health care resource use was valued using 2016/2017 costs, and nonparametric censoring methods were used to estimate total 1-year and 2-year costs.
We identified 854,866 individuals undergoing hip or knee replacement. The mean censor-adjusted 1-year hospitalization costs for hip and knee replacement were £7,827 (95% confidence interval [95% CI] 7,813, 7,842) and £7,805 (95% CI 7,790, 7,818), respectively. Complications and revisions were associated with up to a 3-fold increase in 1-year hospitalization costs. The censor-adjusted 2-year costs were £9,258 (95% CI 9,233, 9,280) and £9,452 (95% CI 9,430, 9,475) for hip and knee replacement, respectively. Adding primary and outpatient care, the mean total hip and knee replacement 2-year costs were £11,987 and £12,578, respectively.
There are significant costs following joint replacement. Revisions and complications accounted for considerable costs and there is a significant incentive to identify best approaches to reduce these.
估算骨关节炎患者初次髋关节和膝关节置换术后 2 年内的成本，比较手术前后的成本，并确定医院成本的预测因素。
从英格兰国家关节登记处（National Joint Registry）中确定了 2008 年至 2016 年间接受初次计划髋关节或膝关节置换术且患有骨关节炎的年龄≥18 岁的患者，并与包含住院病例的医院病例统计数据进行了链接。还使用与医院门诊记录链接的初级保健数据，确定了 2008 年至 2016 年间接受初次髋关节或膝关节置换术的年龄≥18 岁的患者。所有医疗资源的使用均采用 2016/2017 年的成本进行估值，并使用非参数 censoring 方法来估计 1 年和 2 年的总成本。
我们确定了 854866 名接受髋关节或膝关节置换术的患者。髋关节和膝关节置换术的 1 年平均校正 censoring 住院费用分别为 7827 英镑（95%置信区间[95%CI]7813 英镑至 7842 英镑）和 7805 英镑（95%CI 7790 英镑至 7818 英镑）。并发症和翻修与 1 年住院费用增加高达 3 倍有关。髋关节和膝关节置换术的 2 年校正 censoring 费用分别为 9258 英镑（95%CI 9233 英镑至 9280 英镑）和 9452 英镑（95%CI 9430 英镑至 9475 英镑）。如果加上初级保健和门诊护理，髋关节和膝关节置换术的平均 2 年总成本分别为 11987 英镑和 12578 英镑。
关节置换术后存在显著的成本。翻修和并发症造成了相当大的成本，因此有必要确定最佳方法来降低这些成本。
