在全髋关节置换术方面，高值技术利用在医保兜底医院与非医保兜底医院之间的比较。
Comparison of Premium Technology Utilization in Total Hip Arthroplasty Between Safety-net Hospitals and Non-safety-net Hospitals.
机构信息
From the Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA (Sarkovich, Chapple, Dasa, and Krause), the Biostatistics Program, School of Public Health, LSU Health Sciences Center, New Orleans, LA (Chapple), and the Ponce Health Sciences University, School of Medicine, Ponce, Puerto Rico (Sarkovich).
出版信息
J Am Acad Orthop Surg. 2022 Nov 1;30(21):e1402-e1410. doi: 10.5435/JAAOS-D-22-00376. Epub 2022 Aug 9.
INTRODUCTION
The objective of our study was to investigate the association of safety-net hospital (SNH) status with the use of premium technologies in total hip arthroplasty (THA) using the American Academy of Orthopaedic Surgeons American Joint Replacement Registry.
METHODS
Premium technology was defined as having one or more of the following three characteristics: ceramic femoral head, dual mobility (DM) bearing, or surgery conducted with robotic assistance (RA). Patients of all ages were included and subdivided into ceramic femoral head, DM, and RA cohorts. SNH status (based on disproportionate share data), patient demographics, geographical region, hospital size, and teaching affiliation were assessed. Multivariate regression analysis was conducted to analyze any notable associations.
RESULTS
A total of 624,933 THAs between SNHs and non-SNHs were available for analysis. Based on the three different premium technology categories, there were 551,838 THAs for ceramic femoral head utilization analysis, 601,223 THAs for DM utilization analysis, and 199,250 THAs for RA utilization analysis. SNHs were associated with less use of DM and RA (odds ratio [OR] 0.53 P < 0.0001, 0.39 P < 0.0001, respectively). No difference was observed in ceramic femoral head utilization between SNHs and non-SNHs. Patient age was significantly associated with less utilization of all three premium THA technologies (ceramic: OR 0.43 P < 0.0001; DM: OR 0.93 P < 0.0001, RA: OR 0.89 P < 0.001). Teaching hospitals were significantly associated with increased utilization of premium THA technologies (ceramic: OR 1.23 P < 0.0001, DM: OR 1.62 P < 0.0001, RA: OR 5.33 P < 0.001).
CONCLUSION
Premium THA technologies are becoming increasingly used across the US healthcare system; however, that growth is not equal in hospitals with marginalized patient populations. The utilization of ceramic femoral heads is becoming increasingly common across healthcare systems suggesting that ceramic femoral heads may no longer be considered premium technology but rather standard THA care.
LEVEL OF EVIDENCE
Level III.
简介
本研究旨在通过美国骨科医师学会美国关节置换登记处调查安全网医院（SNH）地位与全髋关节置换术（THA）中使用溢价技术之间的关联。
方法
溢价技术被定义为具有以下三个特征之一：陶瓷股骨头、双动（DM）轴承或机器人辅助手术（RA）。纳入了所有年龄段的患者，并分为陶瓷股骨头、DM 和 RA 队列。评估了 SNH 地位（基于不成比例份额数据）、患者人口统计学、地理位置、医院规模和教学隶属关系。进行了多变量回归分析以分析任何显著关联。
结果
共分析了 SNH 和非 SNH 之间的 624933 例 THA。根据三种不同的溢价技术类别，有 551838 例 THA 用于陶瓷股骨头利用分析，601223 例 THA 用于 DM 利用分析，199250 例 THA 用于 RA 利用分析。SNH 与 DM 和 RA 的使用率较低（比值比 [OR] 0.53，P < 0.0001，0.39，P < 0.0001）相关。SNH 和非 SNH 之间的陶瓷股骨头使用率没有差异。患者年龄与所有三种溢价 THA 技术的使用率降低显著相关（陶瓷：OR 0.43，P < 0.0001；DM：OR 0.93，P < 0.0001，RA：OR 0.89，P < 0.001）。教学医院与溢价 THA 技术的使用率增加显著相关（陶瓷：OR 1.23，P < 0.0001，DM：OR 1.62，P < 0.0001，RA：OR 5.33，P < 0.001）。
结论
溢价 THA 技术在美国医疗保健系统中越来越多地使用；然而，在患者人群边缘化的医院中，这种增长并不均衡。陶瓷股骨头的使用率在整个医疗保健系统中变得越来越普遍，这表明陶瓷股骨头可能不再被视为溢价技术，而是标准的 THA 护理。
证据水平
III 级。
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