Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
J Arthroplasty. 2021 Aug;36(8):2685-2690.e1. doi: 10.1016/j.arth.2021.03.034. Epub 2021 Mar 17.
Conversion total knee arthroplasty (convTKA) is associated with increased resource utilization and costs compared with primary TKA. The purpose of this study is to compare 1) surgical time, 2) hospitalization length (LOS), 3) complications, 4) infection, and 5) readmissions in patients undergoing convTKA to both primary TKA and revision TKA patients.
The American College of Surgeons National Surgical Quality Improvement Project database was queried from 2008 to 2018. Patients undergoing convTKA (n = 1,665, 0.5%) were defined by selecting Current Procedural Terminology codes 27,447 and 20,680. We compared the outcomes of interest to patients undergoing primary TKA (n = 348,624) and to patients undergoing aseptic revision TKA (n = 8213). Univariate and multivariate logistic regression was performed to identify the relative risk of postoperative complications.
Compared with patients undergoing primary TKA, convTKA patients were younger (P < .001), had lower body mass index (P < .001), and were less likely to be American Society of Anesthesiologist class III/IV (P < .001). These patients had significantly longer operative times (122.6 vs 90.3 min, P < .001), increased LOS (P < .001), increased risks for any complication (OR 1.94), surgical site infection (OR 1.84), reoperation (OR 2.18), and readmissions (OR 1.60) after controlling for confounders. Compared with aseptic TKA revisions, operative times were shorter (122.6 vs 148.2 min, P < .001), but LOS (2.91 vs 2.95 days, P = .698) was similar. Furthermore, relative risk for any complication (P = .350), surgical site infection (P = .964), reoperation (P = .296), and readmissions (P = .844) did not differ.
Conversion TKA procedures share more similarities with revision TKA rather than primary TKA procedures. Without a distinct procedural and diagnosis-related group, there are financial disincentives to care for these complex patients.
II.
与初次全膝关节置换术（primary TKA）相比，翻修全膝关节置换术（revision TKA）的转换(total)手术时间更长、住院时间（length of stay，LOS）更长、资源利用率更高、花费也更高。本研究旨在比较接受翻修 TKA 患者与初次 TKA 患者及无菌性翻修 TKA 患者之间：1）手术时间；2）住院时间；3）并发症；4）感染；5）再入院的差异。
2008 年至 2018 年，我们查询了美国外科医师学会国家外科质量改进计划数据库。通过选择当前程序术语（Current Procedural Terminology）代码 27447 和 20680，我们将接受翻修 TKA（n=1665，0.5%）的患者定义为。我们将感兴趣的结果与接受初次 TKA（n=348624）和无菌性翻修 TKA（n=8213）的患者进行了比较。我们使用单变量和多变量逻辑回归来确定术后并发症的相对风险。
与初次 TKA 患者相比，翻修 TKA 患者更年轻（P<0.001），体重指数（body mass index，BMI）更低（P<0.001），且美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级为 III/IV 级的可能性更小（P<0.001）。这些患者的手术时间明显更长（122.6 分钟 vs. 90.3 分钟，P<0.001），住院时间更长（P<0.001），且发生任何并发症（比值比 1.94）、手术部位感染（比值比 1.84）、再次手术（比值比 2.18）和再入院（比值比 1.60）的风险更高，这些差异在调整混杂因素后仍然存在。与无菌性翻修 TKA 相比，手术时间更短（122.6 分钟 vs. 148.2 分钟，P<0.001），但 LOS（2.91 天 vs. 2.95 天，P=0.698）相似。此外，任何并发症（P=0.350）、手术部位感染（P=0.964）、再次手术（P=0.296）和再入院（P=0.844）的相对风险无差异。
翻修 TKA 手术与无菌性翻修 TKA 手术的相似之处多于初次 TKA 手术。由于没有明确的手术和诊断相关分组，这些复杂患者的治疗没有经济上的激励。
II 级。
