医院和外科医生手术量对全关节置换术后患者结局的影响：美国关节置换登记处报告。
Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry.
机构信息
From the Division of Ortho Alliance NJ, Orthopedic Institute Brielle Orthopaedics, Manasquan, NJ (Siddiqi), the Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ (Siddiqi), the Department of Orthopedic Surgery, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ (Siddiqi), the Department of Orthopedics, OrthoVirginia, Reston, VA (Alamanda), Plano Orthopedic and Sports Medicine Center, Plano, TX (Barrington), the Department of Orthopedic Surgery, Brigham and Woman's Hospital, Boston, MA (Chen), the American Joint Replacement Registry, American Academy of Orthopedic Surgeons, Chicago, IL (De, Mullen, and Porter), the Department of Orthopedic Surgery, Stanford, Redwood City, CA (Huddlesto), the Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX (Bozic), the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Lewallen), the Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH (Piuzzi), and the Department of Orthopedics Atrium Musculoskeletal Institute (Springer), OrthoCarolina Hip and Knee Center, Charlotte, NC.
出版信息
J Am Acad Orthop Surg. 2022 Jun 1;30(11):e811-e821. doi: 10.5435/JAAOS-D-21-00946. Epub 2022 Feb 21.
BACKGROUND
The purpose of this study was to evaluate outcomes and complications because it relates to surgeon and hospital volume for patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using the American Joint Replacement Registry from 2012 to 2017.
METHODS
A retrospective study was conducted on Medicare-eligible cases of primary elective THAs and TKAs reported to the American Joint Replacement Registry database and was linked with the available Centers of Medicaid and Medicare Services claims and the National Death Index data from 2012 to 2017. Surgeon and hospital volume were defined separately based on the median annual number of anatomic-specific total arthroplasty procedures performed on patients of any age per surgeon and per hospital. Values were aggregated into separate surgeon and hospital volume tertile groupings and combined to create pairwise comparison surgeon/hospital volume groupings for hip and knee.
RESULTS
Adjusted multivariable logistic regression analysis found low surgeon/low hospital volume to have the greatest association with all-cause revisions after THA (odds ratio [OR], 1.63, 95% confidence interval [CI], 1.41-1.89, P < 0.0001) and TKA (OR, 1.72, 95% CI, 1.44-2.06, P < 0.0001), early revisions because of periprosthetic joint infection after THA (OR, 2.50, 95% CI, 1.53-3.15, P < 0.0001) and TKA (OR, 2.18, 95% CI, 1.64-2.89, P < 0.0001), risk of early THA instability and dislocation (OR, 2.47, 95% CI, 1.77-3.46, P < 0.0001), and 90-day mortality after THA (OR, 1.72, 95% CI, 1.27-2.35, P = 0.0005) and TKA (OR, 1.47, 95% CI, 1.15-1.86, P = 0.002).
CONCLUSION
Our findings demonstrate considerably greater THA and TKA complications when performed at low-volume hospitals by low-volume surgeons. Given the data from previous literature including this study, a continued push through healthcare policies and healthcare systems is warranted to direct THA and TKA procedures to high-volume centers by high-volume surgeons because of the evident decrease in complications and considerable costs associated with all-cause revisions, periprosthetic joint infection, instability, and 90-day mortality.
LEVEL OF EVIDENCE
III.
背景
本研究旨在评估接受初次全髋关节置换术（THA）和全膝关节置换术（TKA）的患者的手术医生和医院的手术量，研究数据来自 2012 年至 2017 年的美国关节置换登记处。
方法
对符合医疗保险条件的初次全髋关节置换术和全膝关节置换术患者进行回顾性研究，这些患者的信息均来自美国关节置换登记处数据库，并与 2012 年至 2017 年可获得的医疗补助和医疗保险服务索赔和国家死亡指数数据相关联。手术医生和医院的手术量是根据每个医生和每个医院每年为任何年龄的患者实施的特定解剖全关节置换手术数量的中位数来分别定义的。这些值被汇总到单独的手术医生和医院手术量三分位数分组中，并组合成髋关节和膝关节的配对比较手术医生/医院手术量分组。
结果
多变量逻辑回归分析发现，低手术医生/低医院量与 THA（比值比[OR]，1.63，95%置信区间[CI]，1.41-1.89，P<0.0001）和 TKA（OR，1.72，95% CI，1.44-2.06，P<0.0001）后全因翻修、THA（OR，2.50，95% CI，1.53-3.15，P<0.0001）和 TKA（OR，2.18，95% CI，1.64-2.89，P<0.0001）围手术期关节感染导致的早期翻修、THA 早期不稳定和脱位（OR，2.47，95% CI，1.77-3.46，P<0.0001）以及 90 天死亡率（OR，1.72，95% CI，1.27-2.35，P=0.0005）和 TKA（OR，1.47，95% CI，1.15-1.86，P=0.002）的风险增加有关。
结论
我们的研究结果表明，在低容量医院由低容量手术医生进行手术时，THA 和 TKA 的并发症明显增加。考虑到来自之前文献的研究数据，需要通过医疗保健政策和医疗保健系统持续推动，将 THA 和 TKA 手术引导至高容量中心，由高容量手术医生完成，因为这可以显著降低全因翻修、围手术期关节感染、不稳定和 90 天死亡率等相关并发症的发生率，并显著降低相关成本。
证据水平
III 级。
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