Stock Laura A, Brennan Jane C, Dolle Steffanie S, Turcotte Justin J, King Paul J
Department of Orthopaedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA.
Arthroplast Today. 2022 Apr 8;15:196-201.e2. doi: 10.1016/j.artd.2022.02.031. eCollection 2022 Jun.
The purpose of this study is to evaluate and redefine patients at high risk for increased resource utilization and complications after total joint arthroplasty (TJA), so interventions may focus on patients standing to receive the most benefit.
This is a retrospective study of 787 patients undergoing primary unilateral TJA from September 1, 2020, to September 31, 2021. Patients were deemed to be at "high risk" based on criteria derived from published literature and triaged to an enhanced preoperative education program. Patients that were discharged to a skilled nursing facility, had a length of stay ≥ 2 days, returned to the emergency department, or readmitted within 30 days were classified as having a composite outcome. A univariate analysis compared patients who did and did not experience the composite outcome, and multivariate regression was performed to evaluate predictors of this endpoint.
Differences in rates of 5 of the 28 risk factors were present between patients who did and did not experience composite outcomes. After controlling for other factors, African American race, planned discharge to skilled nursing facility, mental health conditions or drug use, cardiac, and neurologic conditions were predictive of the composite outcome. Patients who were reclassified as "high risk" with 1 or more of these characteristics, experienced longer length of stay and lower rates of home discharge than the rest of the population.
This study presents a profile of high-risk TJA patients that can be incorporated into clinical practice for risk stratification and targeted intervention.
本研究的目的是评估和重新定义全关节置换术（TJA）后资源利用增加和并发症风险较高的患者，以便干预措施能够聚焦于可能获益最大的患者。
这是一项对2020年9月1日至2021年9月31日期间接受初次单侧TJA的787例患者的回顾性研究。根据已发表文献中的标准，将患者判定为“高风险”，并将其分类到强化术前教育项目中。出院后入住专业护理机构、住院时间≥2天、返回急诊科或在30天内再次入院的患者被归类为具有综合结局。单因素分析比较了发生和未发生综合结局的患者，并进行多因素回归分析以评估该终点的预测因素。
发生和未发生综合结局的患者在28个风险因素中的5个因素发生率上存在差异。在控制其他因素后，非裔美国人种族、计划出院后入住专业护理机构、心理健康状况或药物使用情况、心脏和神经疾病是综合结局的预测因素。具有1个或更多这些特征而被重新归类为“高风险”的患者，其住院时间更长，出院回家的比例低于其他人群。
本研究呈现了高风险TJA患者的特征，可将其纳入临床实践用于风险分层和针对性干预。
