Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey.
Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York.
Surg Technol Int. 2021 May 20;38:422-426. doi: 10.52198/21.STI.38.OS1412.
There is an increased incidence of complex patients undergoing total hip arthroplasty (THA), which demands a rigorous preoperative, intraoperative, and postoperative assessment. It is important how increases in patient complexity impact a variety of patient outcomes. Therefore, the purpose of our study is to determine if a higher Elixhauser Comorbidity Index (ECI), a measure of patient complexity, is correlated with: 1) longer hospital length of stay; 2) increased 90-day medical complications; 3) higher 90-day readmissions; and 4) greater two-year implant-related complications following primary THA.
Patients undergoing primary THA from January 1, 2004 to December 31, 2015 were queried from the Medicare Standard Analytical Files using the International Classification of Disease, ninth revision (ICD-9) procedure code 81.51. The queried patients (387,831) were filtered by ECI scores of 1 to 5. Patients who have ECI scores of 2 to 5 represented the study cohorts and were matched according to age and sex to patients who have the lowest ECI score (ECI of 1). All cohorts were longitudinally followed to assess and compare hospital length of stay, 90-day medical complications, 90-day readmissions, and two-year implant-related complications. We compared odds-ratios (OR), 95% confidence intervals (95% CI), and p-values using logistic regression analyses and Welch's t-tests.
Patients who have ECI scores greater than 1 had higher hospital length of stay (p<0.001), 90-day medical complications (p<0.001), 90-day readmissions (p<0.001), and two-year implant-related complications (p<0.001). Patients who have an ECI score of 2 (1.26, 95% CI: 1.20-1.32), ECI of 3 (1.61, 95% CI: 1.53-1.69), ECI of 4 (2.05, 95% CI: 1.95-2.14), and ECI of 5 (2.32, 95% CI: 2.21-2.43) had an increasing trend for readmissions, with higher ECI scores correlating with greater odds of readmission following primary THA. Two-year implant-related complications also showed a similar increasing trend with greater patient complexity. Patients who had an ECI score of 5 (2.54, 95% CI: 2.39-2.69) had more implant-related complications compared to patients who had an ECI score of 2 (1.39, 95% CI:1.31-1.48).
The results of this study illustrate that a higher Elixhauser-Comorbidity Index is an independent risk factor for longer hospital length of stay, higher 90-day medical complications, greater 90-day readmissions, and increased two-year implant-related complications following primary THA. This study is important as it further defines and heightens awareness of adverse events for complex patients undergoing this procedure. Future studies can examine if these events can potentially be mitigated through reductions in ECI scores prior to surgery and increased incentives for the healthcare team.
接受全髋关节置换术 (THA) 的复杂患者数量不断增加，这需要在术前、术中和术后进行严格的评估。了解患者复杂性的增加如何影响各种患者结局非常重要。因此，我们研究的目的是确定更高的 Elixhauser 合并症指数 (ECI)，即患者复杂性的衡量标准，是否与以下因素相关：1）住院时间延长；2）90 天内医疗并发症增加；3）90 天内再入院率增加；4）初次 THA 后两年内与植入物相关的并发症增加。
从 Medicare 标准分析文件中使用国际疾病分类，第 9 版 (ICD-9) 程序代码 81.51 对 2004 年 1 月 1 日至 2015 年 12 月 31 日接受初次 THA 的患者进行查询。查询到的患者（387831 人）根据 ECI 评分 1 至 5 进行过滤。ECI 评分为 2 至 5 的患者代表研究队列，并根据年龄和性别与 ECI 评分最低的患者（ECI 评分为 1）相匹配。所有队列均进行纵向随访，以评估和比较住院时间、90 天内医疗并发症、90 天内再入院率和两年内与植入物相关的并发症。我们使用逻辑回归分析和 Welch's t 检验比较优势比 (OR)、95%置信区间 (95%CI) 和 p 值。
ECI 评分大于 1 的患者住院时间更长 (p<0.001)、90 天内医疗并发症更多 (p<0.001)、90 天内再入院率更高 (p<0.001)、两年内与植入物相关的并发症更多 (p<0.001)。ECI 评分为 2 (1.26，95%CI：1.20-1.32)、ECI 评分为 3 (1.61，95%CI：1.53-1.69)、ECI 评分为 4 (2.05，95%CI：1.95-2.14) 和 ECI 评分为 5 (2.32，95%CI：2.21-2.43) 的患者再入院率呈上升趋势，ECI 评分越高，初次 THA 后再入院的可能性越大。两年内与植入物相关的并发症也呈现出类似的上升趋势，患者复杂性越高。ECI 评分为 5 (2.54，95%CI：2.39-2.69) 的患者与 ECI 评分为 2 (1.39，95%CI：1.31-1.48) 的患者相比，与植入物相关的并发症更多。
本研究结果表明，较高的 Elixhauser 合并症指数是初次 THA 后住院时间延长、90 天内医疗并发症增加、90 天内再入院率增加以及两年内与植入物相关的并发症增加的独立危险因素。本研究很重要，因为它进一步定义并提高了对接受该手术的复杂患者不良事件的认识。未来的研究可以检查这些事件是否可以通过手术前降低 ECI 评分和增加医疗团队的激励措施来潜在地减轻。
