Yakkanti Ramakanth R, Syros Alina, Reddy Gireesh B, D'Apuzzo Michele R
Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA.
Arthroplast Today. 2024 Jan 23;25:101294. doi: 10.1016/j.artd.2023.101294. eCollection 2024 Feb.
Published comparisons between bilateral and unilateral total hip arthroplasty (THA) remain controversial regarding the potential risks and benefits. Our objectives were to compare (1) postoperative complications and (2) resource utilization of patients having simultaneous bilateral THA with patients having unilateral procedures.
The Nationwide Inpatient Sample was used to identify patients undergoing primary elective THA from January 2016 to December 2019. Complications and costs were compared between unilateral and simultaneous bilateral patients. Binary logistic regression analysis controlling demographics, comorbidities, and the primary diagnosis was performed to compare the cohorts of unilateral and bilateral patients.
Nine thousand nine hundred fifty-five Bilateral procedures and 785,609 unilateral procedures were identified. Patients with bilateral procedures were at increased risk for many medical complications including gastrointestinal complications (OR: 4.1; 95% CI: 2.4-6.9, < .01), postoperative blood transfusions (OR: 3.6; 95% CI: 3.3-3.9, < .01), and pulmonary embolisms (OR: 3.2; 95% CI: 2.0-5.1, < .01). Patients with bilateral procedures were also at increased risk for joint complications, including periprosthetic fractures (OR: 7.4; 95% CI: 5.2-10.5, < .01) and other mechanical complications (OR: 27.0; 95% CI: 23-30, < .01). These patients also incurred higher index hospitalization costs ($25,347 vs $16,757, < .001) and were discharged more commonly to a rehabilitation facility (17.8% vs 13.4%, < .001).
Bilateral THA are at increased risk of developing postoperative complications despite being younger and having fewer comorbidities on average when compared with unilateral patients. While bilateral patients had a higher index hospitalization cost, the overall cost of one episode of care is lower than two separate hospitalizations.
关于双侧与单侧全髋关节置换术（THA）的潜在风险和益处，已发表的比较结果仍存在争议。我们的目标是比较：（1）术后并发症；（2）同期双侧THA患者与单侧手术患者的资源利用情况。
利用全国住院患者样本，确定2016年1月至2019年12月期间接受初次择期THA的患者。比较单侧和同期双侧患者的并发症及费用。进行二元逻辑回归分析，控制人口统计学、合并症和主要诊断，以比较单侧和双侧患者队列。
共识别出9955例双侧手术和785609例单侧手术。双侧手术患者发生多种医疗并发症的风险增加，包括胃肠道并发症（比值比：4.1；95%置信区间：2.4 - 6.9，P <.01）、术后输血（比值比：3.6；95%置信区间：3.3 - 3.9，P <.01）和肺栓塞（比值比：3.2；95%置信区间：2.0 - 5.1，P <.01）。双侧手术患者发生关节并发症的风险也增加，包括假体周围骨折（比值比：7.4；95%置信区间：5.2 - 10.5，P <.01）和其他机械并发症（比值比：27.0；95%置信区间：23 - 30，P <.01）。这些患者的首次住院费用也更高（25347美元对16757美元，P <.001），且更常被送往康复机构出院（17.8%对13.4%，P <.001）。
尽管与单侧患者相比，双侧THA患者平均年龄更小且合并症更少，但发生术后并发症的风险增加。虽然双侧患者的首次住院费用较高，但单次治疗的总体费用低于两次单独住院。
