Department of Orthopedic Surgery, University of Miami, Miami, FL.
Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA.
J Arthroplasty. 2022 Jul;37(7):1273-1277. doi: 10.1016/j.arth.2022.02.094. Epub 2022 Feb 28.
Published comparisons between bilateral and unilateral total knee arthroplasties (TKAs) remain biased, as most patients undergoing bilateral TKA are prescreened and healthier than average patients having unilateral procedures. Our objectives were to compare postoperative complications and resource utilization of patients having simultaneous bilateral TKAs with similar patients having unilateral procedures.
The Nationwide Inpatient Sample (NIS) database was used to identify patients undergoing primary elective TKA from 2002 to 2011. A total of 4,445,263 patients were identified. Of these, 190,783 (4%) were having same-day bilateral procedures. Patients with staged bilateral TKA during the same hospitalization were excluded. Complications and costs were compared to a matched cohort of patients having unilateral procedures. This cohort was matched based on age, gender, and 30 comorbid-defined elements in the NIS.
A total of 172,366 (90%) simultaneous bilateral procedures were matched 1:1 to patients with unilateral procedures for the adjusted analysis. Patients with bilateral procedures were at an increased risk for many complications including postoperative anemia (OR: 2.3; 95% CI: 2.2-2.3, P < .001), cardiac (OR: 2.1; 95% CI: 2.0-2.3, P < .001), and inhospital mortality (OR: 3.3; 95% CI: 2.6-4.3). These patients also incurred in higher hospital costs ($19,343 vs $12,852, P < .001) and were discharged more commonly to a rehabilitation facility (70% vs 32%, P < .001).
Patients undergoing simultaneous bilateral TKA are at an increased risk of developing important postoperative complications and mortality compared with unilateral cases. These data highlight the importance of patient selection and optimization for bilateral TKA and potential cost savings.
已发表的双侧和单侧全膝关节置换术（TKA）比较仍存在偏倚，因为大多数接受双侧 TKA 的患者均经过预先筛选，且比接受单侧手术的普通患者更为健康。我们的目的是比较同时进行双侧 TKA 的患者与接受单侧手术的相似患者的术后并发症和资源利用情况。
使用全国住院患者样本（NIS）数据库确定了 2002 年至 2011 年期间接受初次择期 TKA 的患者。共确定了 4445263 例患者。其中，4%（190783 例）为同日双侧手术。排除了同一住院期间分期双侧 TKA 的患者。将并发症和成本与单侧手术的匹配队列进行比较。该队列根据年龄、性别和 NIS 中 30 种合并症定义的元素进行匹配。
共有 172366 例（90%）双侧手术与单侧手术患者进行了 1:1 的调整分析匹配。行双侧手术的患者发生许多并发症的风险增加，包括术后贫血（OR：2.3；95%CI：2.2-2.3，P<0.001）、心脏（OR：2.1；95%CI：2.0-2.3，P<0.001）和院内死亡率（OR：3.3；95%CI：2.6-4.3）。这些患者的住院费用也更高（19343 美元比 12852 美元，P<0.001），且更常被转至康复机构（70%比 32%，P<0.001）。
与单侧病例相比，同时进行双侧 TKA 的患者发生重要术后并发症和死亡的风险增加。这些数据强调了对双侧 TKA 患者进行选择和优化的重要性，以及潜在的成本节约。
