Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
J Arthroplasty. 2021 Jul;36(7):2445-2451.e1. doi: 10.1016/j.arth.2021.02.055. Epub 2021 Mar 1.
Prior ipsilateral knee surgery may increase the risk for complications after total knee arthroplasty (TKA). It remains unclear if the extent of previous surgery affects those risks disparately. The purpose of this study is to evaluate prior nonarthroplasty bony procedure (BP) and soft tissue only procedure (STP) as a potential risk factor for complications after TKA and determine the association with charges or reimbursement of the primary TKA.
Patients who underwent primary TKA with previous knee surgery were identified using a national Medicare database and matched 1:5 to controls without prior knee surgery. Rates of postoperative medical and surgical complications were calculated in addition to hospital-associated charges and reimbursements. Logistic regression analysis was used to control for confounding factors.
Patients who underwent BP (n = 835) had increased risk of readmission (58.6% vs 45.3%, odds ratio (OR) 1.72, 95% confidence interval (CI) 1.59-1.85, P < .001) and emergency room visits (14.5% vs 10.4%, OR 1.44, 95% CI 1.29-1.61, P = .001). Patients who underwent STP (n = 6766) had increased risk of readmission (58.1% vs 45.2%, OR 1.69, 95% CI 1.64-1.73, P < .001), emergency room visits (12.6% vs 0.7%, OR 1.33, 1.28-1.39, P < .001), revision (1.8% vs 1.4%, OR 1.33, 95% CI 1.21-1.47, P = .006), cerebrovascular accident (2.3% vs 1.7%, OR 1.33, 95% CI 1.22-1.46, P = .002), and venous thromboembolism (3.8% vs 3.2%, OR 1.21, 95% CI 1.13-1.29, P = .009). Prior surgery was associated with increased charges and reimbursements.
Prior ipsilateral knee surgery is associated with significantly increased risks of postoperative complications after primary TKA. Interestingly, previous STP but not BP increased the risk of short-term revision and venous thromboembolism.
同侧膝关节手术史可能会增加全膝关节置换术（TKA）后的并发症风险。目前尚不清楚先前手术的范围是否会对这些风险产生不同的影响。本研究的目的是评估非关节置换性骨手术（BP）和单纯软组织手术（STP）作为 TKA 后并发症的潜在危险因素，并确定其与原发性 TKA 的费用或报销之间的关联。
使用国家医疗保险数据库确定接受过原发性 TKA 且有膝关节手术史的患者，并与无膝关节手术史的患者按 1:5 进行匹配。计算术后医疗和手术并发症的发生率，以及医院相关费用和报销情况。采用 logistic 回归分析控制混杂因素。
接受 BP（n=835）的患者再入院率（58.6%比 45.3%，比值比（OR）1.72，95%置信区间（CI）1.59-1.85，P<.001）和急诊就诊率（14.5%比 10.4%，OR 1.44，95% CI 1.29-1.61，P=.001）的风险增加。接受 STP（n=6766）的患者再入院率（58.1%比 45.2%，OR 1.69，95% CI 1.64-1.73，P<.001）、急诊就诊率（12.6%比 0.7%，OR 1.33，1.28-1.39，P<.001）、翻修率（1.8%比 1.4%，OR 1.33，95% CI 1.21-1.47，P=.006）、脑血管意外（2.3%比 1.7%，OR 1.33，95% CI 1.22-1.46，P=.002）和静脉血栓栓塞症（3.8%比 3.2%，OR 1.21，95% CI 1.13-1.29，P=.009）的风险增加。既往手术与费用和报销增加相关。
同侧膝关节手术史与原发性 TKA 后术后并发症的风险显著增加相关。有趣的是，既往 STP 而非 BP 增加了短期翻修和静脉血栓栓塞症的风险。
