Jiang Qiao, Long Huizhong, Xie Dongxing, Li Xiaoxiao, Wang Haibo, Zeng Chao, Lei Guanghua
Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.
J Orthop Translat. 2022 Aug 5;36:75-82. doi: 10.1016/j.jot.2022.05.001. eCollection 2022 Sep.
We aimed to: (1) perform a nationwide trend analysis of staggered and simultaneous bilateral knee arthroplasty (KA); (2) investigate patient demographics and hospital characteristics in two groups; and (3) compare the outcomes of two groups with a focus on complications, length of stay (LOS) and hospitalization costs.
Utilizing the Hospital Quality Monitoring System, we included patients who underwent bilateral KA during a single hospitalization between 2013 and 2019. Patient demographics and hospital characteristics were compared between two groups. Outcomes were compared between propensity-score matched groups using logistic and linear regression.
During the study period, 6291 staggered bilateral KA and 6284 simultaneous bilateral KA were performed. From 2013 to 2019, the proportion of staggered bilateral KA increased from 32.74% to 59.08%. Patients who were older, were single, had more comorbidities and had a non-osteoarthritis indication for surgery tended to receive staggered bilateral KA. Compared with 3327 propensity-score matched patients undergoing simultaneous bilateral KA, patients undergoing staggered bilateral KA were associated with a significantly lower incidence of wound infection (odds ratio [OR] = 0.22; 95% confidence interval [CI], 0.07-0.65), and readmission within 30 days (OR = 0.73; 95%CI, 0.54-0.99) and 90 days (OR = 0.70; 95%CI, 0.55-0.89). However, staggered bilateral KA had higher odds of blood transfusion (OR = 1.20; 95%CI, 1.02-1.40) and deep venous thrombosis (DVT) (OR = 2.62; 95%CI, 1.82-3.98). Moreover, staggered bilateral KA can lead to higher costs (108,316.21 Chinese yuan [CNY] vs 103,367.60 CNY) and longer LOS (17.29 days vs 12.18 days) than simultaneous bilateral KA.
Our study indicates that staggered bilateral KA has become more common than simultaneous bilateral KA in China. Compared to simultaneous bilateral KA, staggered bilateral KA was associated with a lower incidence of wound infection and readmission. Staggered bilateral KA may be an alternative for patients who can't tolerate simultaneous surgery.: Our study indicates that staggered bilateral KA is a safe and economical option for elderly patients who require bilateral KA but are at high clinical risk. The rising proportion of staggered bilateral KA will be a new trend in bilateral KA.
我们旨在：（1）对分期双侧膝关节置换术（KA）和同期双侧膝关节置换术进行全国范围的趋势分析；（2）调查两组患者的人口统计学特征和医院特征；（3）比较两组的结局，重点关注并发症、住院时间（LOS）和住院费用。
利用医院质量监测系统，我们纳入了2013年至2019年期间在单次住院期间接受双侧KA的患者。比较两组患者的人口统计学特征和医院特征。使用逻辑回归和线性回归比较倾向得分匹配组之间的结局。
在研究期间，共进行了6291例分期双侧KA和6284例同期双侧KA。从2013年到2019年，分期双侧KA的比例从32.74%增加到59.08%。年龄较大、单身、合并症较多且有非骨关节炎手术指征的患者倾向于接受分期双侧KA。与3327例倾向得分匹配的同期双侧KA患者相比，分期双侧KA患者的伤口感染发生率显著较低（比值比[OR]=0.22；95%置信区间[CI]，0.07-0.65），30天内再入院率（OR=0.73；95%CI，0.54-0.99）和90天内再入院率（OR=0.70；95%CI，0.55-0.89）。然而，分期双侧KA的输血几率（OR=1.20；95%CI，1.02-1.40）和深静脉血栓形成（DVT）几率（OR=2.62；95%CI，1.82-3.98）较高。此外，分期双侧KA比同期双侧KA导致更高的费用（108316.21元人民币[CNY]对103367.60元人民币）和更长的住院时间（17.29天对12.18天）。
我们的研究表明，在中国，分期双侧KA已比同期双侧KA更为常见。与同期双侧KA相比，分期双侧KA的伤口感染和再入院发生率较低。分期双侧KA可能是不能耐受同期手术患者的一种选择。我们的研究表明，分期双侧KA对于需要双侧KA但临床风险较高的老年患者是一种安全且经济的选择。分期双侧KA比例的上升将是双侧KA的一个新趋势。
