政策变化与新冠疫情对全髋关节置换术后当日出院及并发症的综合影响：一项全国性分析
The combined effect of policy changes and the covid-19 pandemic on the same day discharge and complications following total hip arthroplasty: a nationwide analysis.
作者信息
Gordon Adam M, Magruder Matthew L, Ng Mitchell K, Sheth Bhavya K, Conway Charles A, Hang Jason Wong Che
机构信息
Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, New York, 11219, USA.
出版信息
Arthroplasty. 2022 Aug 1;4(1):28. doi: 10.1186/s42836-022-00131-w.
INTRODUCTION
As a result of the SARS-CoV-2 (COVID-19) pandemic in 2020, elective surgeries, including total joint arthroplasty (TJA), were suspended nationwide. Concurrent removal of total hip arthroplasty (THA) from the Medicare inpatient-only list posed challenges to the delivery of quality patient care with low payor cost. Therefore, the objective of this study was to compare temporal trends in patient demographics, case volumes, length of stay, and complications following elective THA in the years 2019 to 2020 in the United States.
METHODS
The 2019 to 2020 ACS-NSQIP database was queried for elective THA patients. Patients Pre-COVID (2019 and 2020Q1) were compared with post-COVID (2020Q2-Q4). THA utilization, demographics, 30-day complications, and length of stay (LOS) were compared between years. Linear regression evaluated changes in case volumes over time with significance threshold of P < 0.05.
RESULTS
A total of 77,797 patients underwent elective THA in 2019 (n = 43,667) and 2020 (n = 34,130), resulting in a 24.5% decline. Outpatient THA increased in 2020 (35.6%) vs. 2019 (5.7%) (P < 0.001). There was no significant difference in the volume of cases in 2019Q1 through 2019Q4 (P = 0.984). Elective THA volumes declined by 68.8% in 2020Q2, returned to pre-pandemic baseline in 2020Q3, before leveling off at 81.5% of baseline in Q4. Average LOS was significantly shorter in 2020 (1.55 days) vs. 2019 (1.78 days) (P < 0.001) and the proportion of same day discharge (SDD) increased quarterly from 2019 to 2020. There was no significant difference in the total complication rates in 2019 (6.6%) vs. 2020 (6.6%) (P = 0.831).
DISCUSSION
Elective THA precipitously declined during the second quarter of 2020. The combined effect of policy changes and the COVID-19 pandemic resulted in a seven-fold increase in the number of surgeries performed in the outpatient setting in 2020. Rates of SDD doubled over the study period, despite no change in complication rates.
引言
由于2020年新型冠状病毒（COVID-19）大流行，包括全关节置换术（TJA）在内的择期手术在全国范围内暂停。同时，全髋关节置换术（THA）从医疗保险仅涵盖住院患者的清单中移除，这给以低支付者成本提供优质患者护理带来了挑战。因此，本研究的目的是比较2019年至2020年美国择期THA术后患者人口统计学、病例数量、住院时间和并发症的时间趋势。
方法
查询2019年至2020年美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中的择期THA患者。将COVID前（2019年和2020年第一季度）的患者与COVID后（2020年第二季度至第四季度）的患者进行比较。比较各年份之间的THA利用率、人口统计学、30天并发症和住院时间（LOS）。线性回归评估病例数量随时间的变化，显著性阈值为P < 0.05。
结果
2019年（n = 43,667）和2020年（n = 34,130）共有77,797例患者接受了择期THA，下降了24.5%。2020年门诊THA增加（35.6%），而2019年为（5.7%）（P < 0.001）。2019年第一季度至2019年第四季度的病例数量无显著差异（P = 0.984）。2020年第二季度择期THA数量下降了68.8%，2020年第三季度恢复到大流行前的基线水平，然后在第四季度稳定在基线水平的81.5%。2020年的平均住院时间（1.55天）明显短于2019年（1.78天）（P < 0.001），并且从2019年到2020年，当日出院（SDD）的比例按季度增加。2019年（6.6%）和2020年（6.6%）的总并发症发生率无显著差异（P = 0.831）。
讨论
2020年第二季度择期THA急剧下降。政策变化和COVID-19大流行的综合影响导致2020年门诊手术数量增加了七倍。尽管并发症发生率没有变化，但在研究期间，当日出院率翻了一番。
Zotero 插件