The Warren Alpert Medical School of Brown University, Providence, RI.
Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
J Arthroplasty. 2022 Aug;37(8S):S908-S918.e1. doi: 10.1016/j.arth.2022.02.018. Epub 2022 Feb 11.
The purpose of this study is to further characterize the volume dependence of facilities and surgeons on morbidity and mortality after total hip arthroplasty (THA).
Adults who underwent THA from 2009 to 2014 were identified using International Classification of Diseases, Ninth Revision, Clinical Modification and Procedural codes in the New York Statewide Planning and Research Cooperative System database. Complication rates were compared across surgeon and facility volumes using multivariable Cox proportional hazards regression controlling for factors such as the Social Deprivation Index. Surgeon and facility volumes were compared between the low and high volume using cutoffs established by prior research.
In total, 99,832 patients were included. Low volume facilities had higher rates of readmission, urinary tract infection (UTI), acute renal failure, pneumonia, surgical site infection (SSI), cellulitis, wound complications, deep vein thrombosis (DVT), in-hospital mortality, and revision. Low volume surgeons had higher rates of readmission, UTI, acute renal failure, pneumonia, SSI, acute respiratory failure, pulmonary embolism, cellulitis, wound complications, in-hospital mortality, cardiorespiratory arrest, DVT, and revision. African Americans, Hispanics, and those with federal insurance had increased rates of readmission. Those with ≥1 Charlson comorbidities or from areas of higher social deprivation had increased incidence of treatment by low volume surgeons and facilities.
Both low volume facilities and surgeons performing primary THA have higher rates of readmission, UTI, acute renal failure, pneumonia, SSI, cellulitis, wound complications, DVT, in-hospital mortality, and revision. Demographic disparities exist between who is treated at low vs high volume surgeons and facilities placing those groups at higher risks for complications.
本研究旨在进一步描述全髋关节置换术（THA）后设施和外科医生的数量与发病率和死亡率之间的关系。
使用纽约州规划和研究合作系统数据库中的国际疾病分类，第九修订版，临床修正版和程序代码，从 2009 年至 2014 年确定接受 THA 的成年人。使用多变量 Cox 比例风险回归比较外科医生和设施数量在并发症发生率方面的差异，同时控制社会剥夺指数等因素。外科医生和设施数量使用先前研究确定的截止值在低和高容量之间进行比较。
共纳入 99832 例患者。低容量设施的再入院率、尿路感染（UTI）、急性肾衰竭、肺炎、手术部位感染（SSI）、蜂窝织炎、伤口并发症、深静脉血栓形成（DVT）、住院死亡率和翻修率较高。低容量外科医生的再入院率、UTI、急性肾衰竭、肺炎、SSI、急性呼吸衰竭、肺栓塞、蜂窝织炎、伤口并发症、住院死亡率、心搏呼吸骤停、DVT 和翻修率较高。非裔美国人、西班牙裔和拥有联邦保险的人再入院率较高。Charlson 合并症≥1 或来自社会剥夺程度较高地区的患者更倾向于接受低容量外科医生和设施的治疗。
行初次 THA 的低容量设施和外科医生的再入院率、UTI、急性肾衰竭、肺炎、SSI、蜂窝织炎、伤口并发症、DVT、住院死亡率和翻修率较高。在接受低容量外科医生和设施治疗的患者中存在人群差异，这使这些人群面临更高的并发症风险。
