创伤性髋部骨折和原发性选择性全髋关节置换术患者并不相同：共病负担、住院过程、术后并发症和医疗成本分析比较。

Traumatic Hip Fracture and Primary Elective Total Hip Patients are Not the Same: A Comparison of Comorbidity Burden, Hospital Course, Postoperative Complications, and Cost of Care Analysis.

机构信息

Department of Orthopaedic Surgery, University of Arizona College of Medicine Tucson, Tucson, AZ.

Department of Orthopaedic Surgery, University of Arizona College of Medicine Phoenix, Phoenix, AZ; and.

出版信息

J Orthop Trauma. 2020 Nov;34(11):583-588. doi: 10.1097/BOT.0000000000001800.

DOI:10.1097/BOT.0000000000001800

PMID:33065658

Abstract

OBJECTIVES

To compare patient admission comorbidity profiles, length of stay, readmission rate, postoperative complications, mortality rate, and cost of care between acute geriatric hip fractures (HF) and elective total hip arthroplasties (THA).

METHODS

Retrospective cohort.

SETTING

Multicenter health care system.

PATIENTS

Eighteen thousand forty-two geriatric HF treated with operative fixation or arthroplasty and 8761 elective total hip patients were reviewed.

MAIN OUTCOME MEASUREMENTS

Charlson Comorbidity Index, length of stay, ICU admission, readmission rate, postoperative complications, mortality rates, and cost of care.

RESULTS

Medical comorbidities: chronic pulmonary disease, chronic kidney disease, coronary artery disease, heart failure, liver cirrhosis, and cerebrovascular disease were higher in HF patients as was mean Charlson Comorbidity Index (P < 0.001). Albumin was lower and HgbA1c higher in HF patients (P < 0.001). Average length of stay was 5.0 versus 2.6 days (P < 0.001) with 8.5% of HF patients being managed in the ICU versus 1.8% of THA patients. Readmission rates for HF and THA patients were 21.4% and 6.2%, respectively (P < 0.001). Minor and major complications were higher in the HF cohort (P < 0.001), as were 30-day (1.97% vs. 0.17%) and 1-year mortality rates (3.49% vs. 0.40%) (P < 0.001). Mean hospital cost of care was nearly 15,000 US dollars more expensive in HF patients when compared to the elective THA cohort (P < 0.001).

CONCLUSIONS

HF patients have increased comorbidity burdens, lengths of stay, ICU admissions, readmission rates, complications, mortality, and costs of care than patients with elective total hip arthroplasty. In the era of pay for quality performance, health systems must reconcile the difference between these 2 patient cohorts.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较急性老年髋部骨折（HF）和择期全髋关节置换术（THA）患者的入院合并症谱、住院时间、再入院率、术后并发症、死亡率和医疗费用。

方法

回顾性队列研究。

设置

多中心医疗保健系统。

患者

接受手术固定或关节置换治疗的 18042 例老年 HF 患者和 8761 例择期全髋关节置换患者。

主要观察指标

Charlson 合并症指数、住院时间、重症监护病房（ICU）入院率、再入院率、术后并发症、死亡率和医疗费用。

结果

合并症：慢性肺部疾病、慢性肾脏病、冠状动脉疾病、心力衰竭、肝硬化和脑血管疾病在 HF 患者中更为常见，且平均 Charlson 合并症指数更高（P<0.001）。HF 患者的白蛋白水平较低，HgbA1c 水平较高（P<0.001）。HF 患者的平均住院时间为 5.0 天，而 THA 患者为 2.6 天（P<0.001），8.5%的 HF 患者在 ICU 接受治疗，而 THA 患者为 1.8%。HF 和 THA 患者的再入院率分别为 21.4%和 6.2%（P<0.001）。HF 患者的轻微和主要并发症发生率更高（P<0.001），30 天（1.97%比 0.17%）和 1 年死亡率（3.49%比 0.40%）也更高（P<0.001）。与择期 THA 患者相比，HF 患者的住院总费用高出近 15000 美元（P<0.001）。