Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA.
J Arthroplasty. 2021 Jul;36(7):2297-2301.e1. doi: 10.1016/j.arth.2021.02.049. Epub 2021 Feb 25.
On 1/1/2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the Inpatient-Only (IPO) list. This change allowed expansion of outpatient TKA, potentially to include older, more frail patients at greater risk for perioperative complications. The purpose of this study was to evaluate the impact of removing TKA from the IPO list on early complications.
Patients undergoing TKA in the National Surgical Quality Improvement Program database were identified using CPT code 27447. Only cases with length of stay of zero days were included. Rates of 30-day complications, readmissions, and reoperation were compared before and after TKA was removed from the IPO list (2015-2017 vs 2018). The analysis was performed both with and without propensity score matching.
212,313 patients underwent TKA during the study period. 2466 (1.5%) were outpatient TKA in 2015-2017 and 3189 (5.6%) in 2018. After propensity matching, there were 2458 patients in each cohort. Rates of total 30-day complications were significantly lower in 2018 (3.7%) than the years TKA remained on the IPO (4.5%, P = .04). Similarly, rates of any reoperation decreased from 1.2% during 2015-2017 to 0.6% in 2018 (P = .03). There were no significant changes in rates of readmission (2.5% vs 2.2%, P = .5) or wound complications (0.8% vs 0.8%, P = 1.0).
Removal of TKA from the IPO list did not result in an increase in complications or readmissions. These data suggest, despite the regulatory change, surgeons have continued to exercise sound judgment as to what patients can safely undergo outpatient TKA.
2018 年 1 月 1 日，医疗保险和医疗补助服务中心将全膝关节置换术（TKA）从仅限住院治疗（IPO）名单中移除。这一变化允许扩大门诊 TKA，可能包括因围手术期并发症风险较高而更脆弱的老年患者。本研究的目的是评估将 TKA 从 IPO 名单中移除对早期并发症的影响。
使用 CPT 代码 27447 在全国手术质量改进计划数据库中确定接受 TKA 的患者。仅纳入住院时间为零天的病例。比较 TKA 从 IPO 名单中移除前后（2015-2017 年与 2018 年）30 天内并发症、再入院和再次手术的发生率。在不进行和进行倾向评分匹配的情况下均进行了分析。
在研究期间，有 212313 例患者接受了 TKA。2015-2017 年有 2466 例（1.5%）为门诊 TKA，2018 年有 3189 例（5.6%）。在进行倾向评分匹配后，每个队列中有 2458 例患者。2018 年总 30 天并发症发生率明显低于 TKA 留在 IPO 时（3.7%比 4.5%，P=0.04）。同样，任何再手术的发生率从 2015-2017 年的 1.2%降至 2018 年的 0.6%（P=0.03）。再入院率（2.5%比 2.2%，P=0.5）或伤口并发症率（0.8%比 0.8%，P=1.0）无显著变化。
将 TKA 从 IPO 名单中移除并未导致并发症或再入院率增加。这些数据表明，尽管监管发生了变化，但外科医生在确定哪些患者可以安全地接受门诊 TKA 方面仍继续做出明智的判断。
