Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.
Centre Hospitalier Universitaire d'Angers, Angers, France.
J Orthop Surg Res. 2023 Jun 9;18(1):418. doi: 10.1186/s13018-023-03893-4.
Hip arthroplasty is a frequently performed procedure in orthopedic surgery, carried out in almost all health structures for two main issues: fracture and coxarthrosis. Even if volume-outcome relationship appeared associated in many surgeries recently, data provided are not sufficient to set surgical thresholds neither than closing down low-volumes centers.
With this study, we wanted to identify surgical, health care-related and territorial factors influencing patient' mortality and readmission after a HA for a femoral fracture in 2018 in France.
Data were anonymously collected from French nationwide administrative databases. All patients who underwent a hip arthroplasty for a femoral fracture through 2018 were included. Patient outcome was 90-day mortality and 90-day readmission rate after surgery.
Of the 36,252 patients that underwent a HA for fracture in France in 2018, 0.7% died within 90-day year and 1.2% were readmitted. Male and Charlson comorbidity index were associated with a higher 90-day mortality and readmission rate in multivariate analysis. High volume was associated with a lower mortality rate. Neither time of travel nor distance upon health facility were associated with mortality nor with readmission rate in the analysis.
Even if volume appears to be associated with lower mortality rate even for longer distance and time of travel, the persistence of exogenous factors not documented in the French databases suggests that regionalization of hip arthroplasty should be organized with caution.
As volume-outcome relationship must be interpreted with caution, policy makers should not regionalize such surgery without further investigation.
髋关节置换术是骨科中经常进行的手术，几乎在所有医疗机构中都针对两个主要问题进行：骨折和髋关节骨关节炎。尽管最近许多手术的结果与手术量之间存在关联，但提供的数据不足以确定手术阈值，也不足以关闭低容量中心。
本研究旨在确定 2018 年法国髋关节置换术治疗股骨骨折患者的手术、医疗保健相关和地域因素对患者死亡率和术后 90 天再入院率的影响。
数据从法国全国行政数据库匿名收集。所有在 2018 年接受髋关节置换术治疗股骨骨折的患者均被纳入研究。患者的预后为术后 90 天死亡率和 90 天再入院率。
在 2018 年法国接受髋关节置换术治疗骨折的 36252 例患者中，0.7%的患者在 90 天内死亡，1.2%的患者再次入院。在多变量分析中，男性和 Charlson 合并症指数与较高的 90 天死亡率和再入院率相关。高手术量与较低的死亡率相关。在分析中，旅行时间和距离与死亡率或再入院率均无关。
即使手术量与较低的死亡率相关，即使旅行时间和距离较长，由于法国数据库中未记录的外生因素的存在，髋关节置换术的区域化仍应谨慎进行。
由于结果与手术量之间的关系必须谨慎解释，政策制定者在没有进一步调查的情况下不应将此类手术进行区域化。
