Harper Katharine D, Sullivan Thomas C, Wininger Austin, Incavo Stephen J, Lambert Bradley S
Department of Orthopedic Surgery, Washington DC VA Medical Center, Washington, DC, USA.
Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA.
HSS J. 2024 Feb;20(1):57-62. doi: 10.1177/15563316231209308. Epub 2023 Nov 25.
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are no longer considered inpatient-only procedures. Qualifying for inpatient status reimbursement requires additional, unreimbursed administrative effort, and may limit care to these patients. : We sought to evaluate and compare the overall health status of patients receiving THA and TKA. : We conducted a retrospective review evaluating 2207 patients undergoing primary THA and TKA from 2015 to 2018 at a single institution. Clinical parameters, surgical procedure, medical history, laboratory values, length of stay (LOS), and discharge location were recorded and compared between the 2 groups. : In 2202 patients, we observed differences for body mass index (THA = 29.4 ± 0.4, TKA = 32.1 ± 0.3), low-density lipoprotein cholesterol levels (THA = 105.8 ± 13.5 mg/dL; TKA = 128.6 ± 13.7 mg/dL), and blood glucose levels (THA = 98.2 ± 1.7 mg/dL; TKA = 101.4 ± 1.3 mg/dL), indicating that TKA patients were more likely than THA patients to be classified as obese, hypercholesterolemic, and hyperglycemic. We observed longer LOS in THA patients (51.25 hours, 95% CI ± 3.87 hours) than in TKA patients (36.93 hours, 95% CI ± 1.17 hours). A greater proportion of TKA patients were discharged home (81.97%, = 1155) rather than to additional care facilities compared with THA patients (71.84%, = 539). : In this retrospective study, we observed that TKA patients had higher rates of comorbidities than did THA patients, but TKA patients spent less time in the hospital and were more likely to be discharged home. Future studies should evaluate reasons for poor clinical outcomes for patients undergoing total joint arthroplasty with an outpatient designation.
全髋关节置换术（THA）和全膝关节置换术（TKA）不再仅被视为需住院治疗的手术。符合住院状态报销要求需要额外的、无法报销的行政工作，并且可能会限制对这些患者的护理。我们试图评估和比较接受THA和TKA的患者的整体健康状况。我们进行了一项回顾性研究，评估了2015年至2018年在一家机构接受初次THA和TKA的2207例患者。记录并比较了两组患者的临床参数、手术过程、病史、实验室值、住院时间（LOS）和出院地点。在2202例患者中，我们观察到体重指数存在差异（THA = 29.4±0.4，TKA = 32.1±0.3）、低密度脂蛋白胆固醇水平（THA = 105.8±13.5mg/dL；TKA = 128.6±13.7mg/dL）和血糖水平（THA = 98.2±1.7mg/dL；TKA = 101.4±1.3mg/dL），这表明TKA患者比THA患者更有可能被归类为肥胖、高胆固醇血症和高血糖症。我们观察到THA患者的住院时间（51.25小时，95%CI±3.87小时）比TKA患者（36.93小时，95%CI±1.17小时）更长。与THA患者（71.84%，n = 539）相比，更大比例的TKA患者出院回家（81.97%，n = 1155）而不是前往其他护理机构。在这项回顾性研究中，我们观察到TKA患者的合并症发生率高于THA患者，但TKA患者在医院的停留时间更短，并且更有可能出院回家。未来的研究应该评估门诊指定的全关节置换术患者临床结果不佳的原因。
