From the Medical College of Wisconsin, Milwaukee, WI (Ahmed); the Department of Surgery (Dr. Tian and Dr. Ghomrawi), Surgical Outcomes and Quality Improvement Center (Dr. Tian), Health Sciences Integrated PhD Program (Dr. Hasan and Harris), Center for Health Services and Outcomes Research (Dr. Ghomrawi), the Department of Medicine (Rheumatology) (Dr. Ghomrawi), the Department of Pediatrics (Dr. Ghomrawi), Feinberg School of Medicine, Northwestern University, Chicago, IL.
J Am Acad Orthop Surg Glob Res Rev. 2022 Jun 10;6(6). doi: 10.5435/JAAOSGlobal-D-22-00089. eCollection 2022 Jun 1.
Population-based studies showing the advantage of computer-assisted total knee arthroplasty (CATKA) over conventional total knee arthroplasty (TKA) are outdated. More recent institution-based studies with relatively small sample sizes may hinder wider adoption. This cohort-based study aimed to compare postoperative CATKA and TKA in-hospital complications and 90-day all-cause readmissions using 2017-2018 data.
Patients who underwent a primary unilateral CATKA or TKA were identified in the New York Statewide Planning and Research Cooperative System database. In-hospital complications were defined based on the 2020 Centers for Medicare & Medicaid Services total hip arthroplasty and TKA complications measure. Ninety-day readmissions were identified using unique patient identifiers. Logistic regression with a generalized estimating equation was used to assess associations of computer assistance with in-hospital complications and 90-day all-cause readmissions.
A total of 80,468 TKAs were identified during the study period, of which 7,395 (9.2%) were CATKAs. Significantly fewer complications occurred among patients who had CATKAs compared with conventional TKAs (0.4% of total CATKAs vs 2.6% of total conventional TKAs, P < 0.001); patients who had CATKAs had fewer 90-day all-cause readmissions compared with those who underwent TKAs (363 vs 4,169 revisits, P < 0.01). Computer assistance was associated with significantly lower odds of in-hospital complications (odds ratio, 0.15, 95% confidence interval, 0.09 to 0.24; P < 0.05) but not 90-day all-cause readmissions.
Patients undergoing CATKAs had markedly lower odds of in-hospital complications, compared with patients having TKAs, which has implications for both patient outcomes and hospital reimbursement. These more recent cohort-based findings encourage wider CATKA adoption.
基于人群的研究表明，计算机辅助全膝关节置换术（CATKA）优于传统全膝关节置换术（TKA），但这些研究已经过时。最近一些基于机构的研究样本量相对较小，可能会阻碍其更广泛的应用。本队列研究旨在使用 2017-2018 年的数据，比较术后 CATKA 和 TKA 的住院并发症和 90 天全因再入院率。
在纽约州规划和研究合作系统数据库中确定接受初次单侧 CATKA 或 TKA 的患者。根据 2020 年医疗保险和医疗补助服务中心全髋关节置换术和 TKA 并发症测量标准，定义住院并发症。使用唯一患者标识符确定 90 天再入院情况。使用广义估计方程的 logistic 回归评估计算机辅助与住院并发症和 90 天全因再入院的关联。
研究期间共确定了 80468 例 TKA，其中 7395 例（9.2%）为 CATKA。与传统 TKA 相比，接受 CATKA 的患者并发症发生率显著较低（CATKA 总例数的 0.4%比传统 TKA 总例数的 2.6%，P<0.001）；与 TKA 相比，接受 CATKA 的患者 90 天全因再入院率较低（363 例与 4169 例再入院，P<0.01）。计算机辅助与住院并发症发生的可能性显著降低相关（比值比，0.15；95%置信区间，0.09-0.24；P<0.05），但与 90 天全因再入院无关。
与接受 TKA 的患者相比，接受 CATKA 的患者住院并发症的可能性显著降低，这对患者结局和医院报销都有影响。这些基于更近期队列的研究结果鼓励更广泛地采用 CATKA。
