The Affiliated Hospital of Qingdao University, QingDao, China.
Medical College, Qingdao University, Qingdao, China.
BMJ Open. 2021 Mar 2;11(3):e041147. doi: 10.1136/bmjopen-2020-041147.
Total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is required for many patients. This study aimed to evaluate the medical costs, length of stay (LOS), blood transfusion and in-hospital complications in patients undergoing simultaneous and staged TJA.
All patients who underwent primary bilateral TJA from 2013 to 2018 in our institute were included. The propensity score matching analysis was performed between simultaneous and staged TJA patients. The difference in medical costs, LOS, blood transfusion and in-hospital complications was compared between simultaneous and staged groups.
Except for materials fees and general therapy fees, medical costs (bed fees, general therapy fees, nursing care fees, check-up and laboratory test fees, surgical fees and drug fees) were significantly lower in the simultaneous TKA, THA and TJA group. The total average medical costs in simultaneous and staged TKA groups were $15 385 and $16 729 (p<0.001), respectively; THA groups were $14 503 and $16 142 (p=0.016), respectively; TJA groups were $15 389 and $16 830 (p<0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common comorbidities and postoperative complications between the two subgroups. The simultaneous groups had a shorter LOS and the differences from the staged group for TKA, THA and the TJA group were 8, 6 and 8 days, respectively. The incidence of blood transfusion is higher for simultaneous groups and the difference from the staged group for TKA, THA and TJA is 32.69%, 18% and 29.3%, respectively.
Our results indicate that simultaneous TKA and THA with a shorter LOS would cost fewer (costs incurred during hospitalisation) than staged TKA and THA. Complication rates were not affected by the choice for staged or simultaneous arthroplasty, but the incidence of blood transfusion was higher in the simultaneous groups.
全关节置换术（TJA），包括全膝关节置换术（TKA）和全髋关节置换术（THA），是许多患者所需要的。本研究旨在评估同时性和分期性 TJA 患者的医疗费用、住院时间（LOS）、输血和院内并发症。
纳入 2013 年至 2018 年在我院行初次双侧 TJA 的所有患者。对同时性和分期性 TJA 患者进行倾向评分匹配分析。比较同时性和分期性两组之间的医疗费用、住院时间、输血和院内并发症的差异。
除材料费用和一般治疗费用外，同时性 TKA、THA 和 TJA 组的医疗费用（床位费、一般治疗费、护理费、检查和实验室检验费、手术费和药费）显著降低。同时性和分期性 TKA 组的总平均医疗费用分别为 15385 美元和 16729 美元（p<0.001）；THA 组分别为 14503 美元和 16142 美元（p=0.016）；TJA 组分别为 15389 美元和 16830 美元（p<0.001）。最高和最低费用分别为材料费用和护理费用。两组亚组之间的五种常见合并症和术后并发症无显著差异。同时性组的 LOS 较短，与分期性组相比，TKA、THA 和 TJA 组的 LOS 分别缩短 8、6 和 8 天。输血的发生率更高同时性组，与分期性组相比，TKA、THA 和 TJA 的差异分别为 32.69%、18%和 29.3%。
我们的结果表明，同时性 TKA 和 THA 具有较短的 LOS，其费用（住院期间发生的费用）低于分期性 TKA 和 THA。选择分期或同时性关节置换术不会影响并发症发生率，但同时性组的输血发生率更高。
