Suarez Juan C, Saxena Anshul, Arguelles William, Watson Perez John M, Ramamoorthy Venkataraghavan, Hernandez Yvette, Osondu Chukwuemeka U
Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL, USA.
Center for Advanced Analytics, Baptist Health South Florida, Coral Gables, FL, USA.
Arthroplast Today. 2022 Aug 29;17:114-119. doi: 10.1016/j.artd.2022.06.017. eCollection 2022 Oct.
When clinically indicated, the choice of performing a total knee arthroplasty (TKA) vs a unicompartmental knee arthroplasty (UKA) is dictated by patient and surgeon preferences. Increased understanding of surgical morbidity may enhance this shared decision-making process. This study compared 30-day risk-adjusted outcomes in TKA vs UKA using a national database.
We analyzed data from the National Safety and Quality Improvement Program database, for patients who received TKA or UKA between 2014-2018. The main outcomes were blood transfusion, operation time, length of stay, major complication, minor complication, unplanned reoperation, and readmission. Comparisons of odds of the outcomes of interest between TKA and UKA patients were analyzed using multivariate regression models accounting for confounders.
We identified 274,411 eligible patients, of whom 265,519 (96.7%) underwent TKA, while 8892 (3.3%) underwent UKA. Risk-adjusted models that compared perioperative and postoperative outcomes of TKA and UKA showed that the odds of complications such as blood transfusion (adjusted odds ratio [aOR], 19.74; 95% confidence interval [CI]: 8.19-47.60), major (aOR, 1.87; 95% CI: 1.27-2.77) and minor complications (aOR, 1.43; 95% CI: 1.14-1.79), and readmission (aOR, 1.41; 95% CI: 1.16-1.72) were significantly higher among patients who received TKA than among those who received UKA. In addition, operation time (aOR, 7.72; 95% CI: 6.72-8.72) and hospital length of stay (aOR, 1.11; 95% CI: 1.05-1.17) were also higher among the TKA recipients compared to those who received UKA.
UKA is associated with lower rates of adverse perioperative outcomes compared to TKA. Clinical indications and surgical morbidity should be considered in the shared-decision process.
在有临床指征时，选择进行全膝关节置换术（TKA）还是单髁膝关节置换术（UKA）取决于患者和外科医生的偏好。对手术并发症的进一步了解可能会加强这种共同决策过程。本研究使用国家数据库比较了TKA和UKA患者30天风险调整后的结局。
我们分析了国家安全与质量改进计划数据库中2014年至2018年间接受TKA或UKA治疗的患者数据。主要结局包括输血、手术时间、住院时间、主要并发症、次要并发症、计划外再次手术和再入院。使用考虑混杂因素的多变量回归模型分析TKA和UKA患者之间感兴趣结局的比值比。
我们确定了274411例符合条件的患者，其中265519例（96.7%）接受了TKA，而8892例（3.3%）接受了UKA。比较TKA和UKA围手术期和术后结局的风险调整模型显示，接受TKA的患者输血（调整后比值比[aOR]，19.74；95%置信区间[CI]：8.19 - 47.60）、主要（aOR，1.87；95% CI：1.27 - 2.77）和次要并发症（aOR，1.43；95% CI：1.14 - 1.79）以及再入院（aOR，1.41；95% CI：1.16 - 1.72）的发生率显著高于接受UKA的患者。此外，与接受UKA的患者相比，TKA接受者的手术时间（aOR，7.72；95% CI：6.72 - 8.72）和住院时间（aOR，1.11；95% CI：1.05 - 1.17）也更长。
与TKA相比，UKA围手术期不良结局的发生率较低。在共同决策过程中应考虑临床指征和手术并发症。
