Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.
Bone Joint J. 2021 Jun;103-B(6 Supple A):23-31. doi: 10.1302/0301-620X.103B6.BJJ-2020-2259.R1.
The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA).
The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts.
Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425).
Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: 2021;103-B(6 Supple A):23-31.
本研究旨在比较行单髁膝关节置换术（UKA）和全膝关节置换术（TKA）患者十年的纵向医疗保健成本和翻修率。
使用 Humana 数据库比较了 2007 年至 2009 年间接受 UKA 的 2383 例患者，根据年龄、性别和 Elixhauser 合并症指数，从接受初次 TKA 的 63036 例患者队列中 1:1 匹配。术后一年对医疗和手术并发症进行了纵向跟踪。记录了在此期间的翻修手术率和累积平均医疗保健成本，并对队列进行了比较。
接受 TKA 的患者麻醉下手法复位（3.9%比 0.9%；p < 0.001）、深静脉血栓形成（5.0%比 3.1%；p < 0.001）、肺栓塞（1.5%比 0.8%；p = 0.001）和肾衰竭（4.2%比 2.2%；p < 0.001）的发生率明显更高。然而，UKA 的五年（6.0%比 4.2%；p = 0.007）和十年（6.5%比 4.4%；p = 0.002）后翻修率明显更高。接受 TKA 的患者在一年（$24771 比 $22071；p < 0.001）和五年（$26549 比 $25730；p < 0.001）后的纵向相关医疗保健成本高于接受 UKA 的患者；然而，在十年时 TKA 的平均成本与 UKA 相当（$26877 比 $26891；p = 0.425）。
尽管 UKA 的翻修率较高，但在术后十年内，接受 UKA 的患者的平均医疗保健成本低于接受 TKA 的患者，在这一时期，成本相当。在基于价值的护理时代，外科医生和决策者应该意识到这些手术的相关成本。UKA 在术后一年的并发症发生率较低，但五年和十年的翻修率较高。虽然 UKA 在一年和五年时的成本明显低于 TKA，但十年时的成本相当，平均差异仅为 14 美元。降低翻修手术的风险应该是 UKA 和 TKA 的成本节约的目标，因为需要翻修手术的患者的相关医疗保健成本增加了 2.5 倍。
脚注：1. Elixhauser 合并症指数：一种基于诊断的评估方法，用于预测患者的合并症严重程度和死亡率。它考虑了 30 多种常见的合并症，并将其分为 19 个不同的类别。2. 深静脉血栓形成（DVT）：一种在深静脉中形成的血栓，通常在腿部。如果血栓脱落并移动到肺部，就会导致肺栓塞（PE）。3. 肺栓塞（PE）：一种在肺部形成的血栓，通常是由于深静脉血栓形成脱落并移动到肺部。PE 可能导致呼吸困难、胸痛、心跳加快等症状。4. 肾衰竭（Renal failure）：肾脏功能不全或丧失的一种疾病，可能导致体内毒素和废物积聚，水和电解质平衡失调等问题。5. 基于价值的护理（Value-based care）：一种医疗保健模式，旨在通过提高医疗保健的质量和效果，同时降低成本，为患者提供更好的医疗保健体验。
