Hadid Bana, Buehring Weston, Mannino Angelo, Weisberg Miriam D, Golub Ivan J, Ng Mitchell K, Razi Afshin E
Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York.
School of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.
J Knee Surg. 2023 Apr;36(5):524-529. doi: 10.1055/s-0041-1739199. Epub 2021 Nov 18.
The literature has shown an increase in prevalence of Crohn's disease (CD) within the United States alongside a concomitant rise in primary total knee arthroplasty (TKA) procedures. As such, with these parallel increases, orthopaedic surgeons will invariably encounter CD patients requiring TKA. Limited studies exist evaluating the impact of this disease on patients undergoing the procedure; therefore, this study endeavors to determine whether CD patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) medical complications, and (3) episode of care (EOC) costs. To accomplish this, a nationwide database was queried from January 1, 2005 to March 31, 2014 to identify patients undergoing TKA. The study group, patients with CD, was randomly matched to the controls, patients without CD, in a 1:5 ratio after accounting for age, sex, and medical comorbidities associated with CD. Patients consuming corticosteroids were excluded, as they are at risk of higher rates of adverse events following TKA. This query ultimately yielded a total of 96,213 patients, with 16,037 in the study cohort and 80,176 in the control one. The study compared in-hospital (LOS), 90-day medical complications, and day of surgery and total global 90-day EOC costs between CD and non-CD patients undergoing primary TKA. The results found CD patients undergoing primary TKA had significantly longer in-hospital LOS (4- vs. 3 days, 0.0001) compared with non-CD patients. CD patients were also found to have significantly higher incidence and odds of 90-day medical complications (25.31 vs. 10.75; odds ratio: 2.05, 0.0001) compared with their counterparts. Furthermore, CD patients were found to have significantly higher 90-day EOC costs ($15,401.63 vs. 14,241.15, 0.0001) compared with controls. This study demonstrated that, after adjusting for age, sex, and medical comorbidities, patients with CD have prolonged in-hospital LOS, increased medical complications, and higher EOC costs following primary TKA. Therefore, it establishes the importance for orthopaedists to adequately counsel CD patients of the potential complications and outcomes following their procedure.
文献表明，美国克罗恩病（CD）的患病率有所上升，同时初次全膝关节置换术（TKA）的手术量也随之增加。因此，随着这两种情况的平行增长，骨科医生必然会遇到需要进行TKA的CD患者。目前评估这种疾病对接受该手术患者影响的研究有限；因此，本研究旨在确定接受初次TKA的CD患者是否有更高的（1）住院时间（LOS）、（2）医疗并发症发生率和（3）护理期间费用（EOC）。为实现这一目标，我们查询了2005年1月1日至2014年3月31日的全国性数据库，以识别接受TKA的患者。在考虑年龄、性别和与CD相关的医疗合并症后，将研究组（CD患者）与对照组（非CD患者）按1:5的比例进行随机匹配。服用皮质类固醇的患者被排除在外，因为他们在TKA后发生不良事件的风险较高。此次查询最终共得到96213名患者，其中研究队列中有16037名，对照组中有80176名。该研究比较了接受初次TKA的CD患者和非CD患者的住院LOS、90天医疗并发症以及手术日和90天总体EOC费用。结果发现，与非CD患者相比，接受初次TKA的CD患者住院LOS明显更长（4天对3天，P<0.0001）。还发现CD患者90天医疗并发症的发生率和几率也明显高于非CD患者（25.31对10.75；优势比：2.05，P<0.0001）。此外，与对照组相比，CD患者的90天EOC费用明显更高（15401.63美元对14241.15美元，P<0.0001）。本研究表明，在调整年龄、性别和医疗合并症后，CD患者在初次TKA后住院LOS延长，医疗并发症增加，EOC费用更高。因此，该研究确立了骨科医生向CD患者充分告知手术潜在并发症和结果的重要性。
