评估全肘关节置换术的医院量效关系。
Assessing the hospital volume-outcome relationship in total elbow arthroplasty.
机构信息
College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA.
出版信息
J Shoulder Elbow Surg. 2022 Feb;31(2):367-374. doi: 10.1016/j.jse.2021.08.025. Epub 2021 Sep 27.
BACKGROUND
Total elbow arthroplasty (TEA) is an effective intervention for multiple elbow disorders including complex fracture in elderly patients, post-traumatic arthropathy, inflammatory arthropathy, and distal humeral nonunion. Given its known therapeutic value and low utilization rate, an investigation into the thresholds for TEA institutional volume-outcome relationships is warranted. The purpose of this study was to identify TEA volume thresholds that serve as predictors of institutional outcomes including complications, readmissions, revisions, cost of care, length of stay (LOS), and non-home discharge. We hypothesized that increased institutional volume would be associated with decreased 90-day adverse outcomes and resource utilization.
METHODS
The Nationwide Readmission Database was queried from 2010 to 2017 to identify all cases of TEA. Hospital volume was calculated using a unique hospital identifier and divided into quartiles. Outcomes such as complications, readmissions, revisions, cost of care, LOS, and non-home discharge were then analyzed by quartile. The same outcomes were assessed via stratum-specific likelihood ratio (SSLR) analysis to define volume strata among institutions.
RESULTS
SSLR analysis defined statistically significant hospital volume categories for each 90-day outcome. The volume category with the lowest complication rate was ≥21 TEAs per year (5.6%). The volume categories with the lowest readmission rates were 1-3 TEAs per year (4.7%) and ≥18 TEAs per year (9.2%). Revision rates were lowest in the volume categories of 1-5 TEAs per year (0.1%) and ≥18 TEAs per year (0.1%). Hospitals with ≥21 TEAs per year had the lowest cost of care and the highest rate of extended LOS (>2 days). SSLR analysis showed that non-home discharges decreased in a stepwise manner as volume increased. The lowest non-home discharge rate was associated with the volume category of ≥22 TEAs per year (20.3%).
CONCLUSION
This study defines TEA volume strata for institutional outcomes. The highest TEA volume strata were associated with the lowest rates of 90-day complications, revisions, and non-home discharges and the lowest cost of care. This trend is likely attributable to the benefits of high-volume institutional experience and standardized patient-care processes.
背景
全肘关节置换术（TEA）是一种有效的治疗方法，可用于多种肘关节疾病，包括老年患者的复杂骨折、创伤后关节炎、炎症性关节炎和肱骨远端骨不连。鉴于其已知的治疗价值和低利用率，有必要对 TEA 机构数量与结果关系的阈值进行调查。本研究的目的是确定 TEA 量阈值，这些阈值可作为机构结果的预测指标，包括并发症、再入院、翻修、护理成本、住院时间（LOS）和非家庭出院。我们假设机构数量的增加与 90 天不良结果和资源利用的减少有关。
方法
从 2010 年到 2017 年，全国再入院数据库被查询以确定所有 TEA 病例。使用独特的医院标识符计算医院量，并将其分为四分之一。然后按四分位数分析并发症、再入院、翻修、护理成本、LOS 和非家庭出院等结果。通过分层特异性似然比（SSLR）分析评估相同的结果，以定义机构之间的量分层。
结果
SSLR 分析为每个 90 天结果定义了具有统计学意义的医院量类别。并发症发生率最低的量类别为每年≥21 例 TEA（5.6%）。再入院率最低的量类别为每年 1-3 例 TEA（4.7%）和每年≥18 例 TEA（9.2%）。每年 1-5 例 TEA（0.1%）和每年≥18 例 TEA（0.1%）的翻修率最低。每年≥21 例 TEA 的医院护理成本最低，LOS 延长率（>2 天）最高。SSLR 分析表明，非家庭出院率随着量的增加呈逐步下降趋势。非家庭出院率最低的量类别与每年≥22 例 TEA 的量类别（20.3%）相关。
结论
本研究定义了 TEA 机构结果的量分层。最高 TEA 量类别与 90 天内并发症、翻修和非家庭出院率最低以及护理成本最低相关。这种趋势可能归因于高量机构经验和标准化患者护理流程的益处。
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