Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
J Arthroplasty. 2023 Jul;38(7S):S23-S28. doi: 10.1016/j.arth.2023.03.007. Epub 2023 Mar 8.
On January 1, 2020, the Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the Inpatient-Only (IPO) list. This study evaluated patient demographics and comorbidities, preoperative optimization efforts, and 30-day outcomes of patients undergoing outpatient THA before and after IPO removal. The authors hypothesized that patients undergoing THA post-IPO removal would have improved optimization of modifiable risk factors and equivalent 30-day outcomes.
There were 17,063 outpatient THAs in a national database stratified by surgery performed before (2015 to 2019: 5,239 patients) and after IPO (2020: 11,824 patients) removal. Demographics, comorbidities, and 30-day outcomes were compared with univariable and multivariable analyses. Preoperative optimization thresholds were established for the following modifiable risk factors: albumin, creatinine, hematocrit, smoking history, and body mass index. The percentage of patients who fell outside the thresholds in each cohort were compared.
Patients undergoing outpatient THA post-IPO removal were significantly older; mean age 65 years (range, 18 to 92) versus 62 (range, 18 to 90) years (P < .01), with a higher percentage of American Society of Anesthesiologists scores 3 and 4 (P < .01). There was no difference in 30-day readmissions (P = .57) or reoperations (P = 1.00). A significantly lower percentage of patients fell outside the established threshold for albumin (P < .01) post-IPO removal, and trended towards lower percentages for hematocrit and smoking status.
The removal of THA from the IPO list expanded patient selection for outpatient arthroplasty. Preoperative optimization is critical to minimize postoperative complications, and the current study demonstrates that 30-day outcomes have not worsened post-IPO removal.
2020 年 1 月 1 日，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）将全髋关节置换术（total hip arthroplasty，THA）从仅限住院治疗（Inpatient-Only，IPO）名单中移除。本研究评估了接受门诊 THA 治疗的患者在 IPO 移除前后的人口统计学和合并症、术前优化措施以及 30 天结果。作者假设，IPO 移除后接受 THA 治疗的患者可更好地优化可改变的危险因素，并获得同等的 30 天结果。
在一个全国性数据库中，对接受门诊 THA 治疗的患者进行了分层，手术时间在 IPO 移除之前（2015 年至 2019 年：5239 例患者）和之后（2020 年：11824 例患者）。使用单变量和多变量分析比较了人口统计学、合并症和 30 天结果。为以下可改变的危险因素设定了术前优化阈值：白蛋白、肌酐、血细胞比容、吸烟史和体重指数。比较了每个队列中不符合阈值的患者比例。
IPO 移除后接受门诊 THA 治疗的患者年龄明显更大；平均年龄 65 岁（范围 18 至 92 岁），而 62 岁（范围 18 至 90 岁）（P<.01），美国麻醉医师协会（American Society of Anesthesiologists）评分 3 级和 4 级的患者比例更高（P<.01）。30 天内再入院率（P=.57）或再手术率（P=1.00）无差异。IPO 移除后，白蛋白不符合既定阈值的患者比例显著降低（P<.01），而血细胞比容和吸烟状态的百分比也呈下降趋势。
THA 从 IPO 名单中移除扩大了门诊关节置换术的患者选择。术前优化对于最大限度地减少术后并发症至关重要，本研究表明 IPO 移除后 30 天结果并未恶化。
