Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois.
J Arthroplasty. 2024 Sep;39(9S2):S367-S373. doi: 10.1016/j.arth.2024.04.032. Epub 2024 Apr 17.
Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) tremendously burden hospital resources. This study evaluated factors influencing perioperative costs, including emergency department (ED) visits, readmissions, and total costs-of-care within 90 days following revision surgery.
A retrospective analysis of 772 revision TKAs and THAs performed on 630 subjects at a single center between January 2007 and December 2019 was conducted. Cost data were available from January 2015 to December 2019 for 277 patients. Factors examined included comorbidities, demographic information, preoperative Anesthesia Society of Anesthesiologists score, implant selection, and operative indication using mixed-effects linear regression models.
Among 772 revisions (425 THAs and 347 TKAs), 213 patients required an ED visit, and 90 required hospital readmission within 90 days. There were 22.6% of patients who underwent a second procedure after their initial revision. Liver disease was a significant predictor of ED readmission for THA patients (multivariable odds ratio [OR]: 3.473, P = .001), while aseptic loosening, osteolysis, or instability significantly reduced the odds of readmission for TKA patients (OR: 0.368, P = .014). In terms of ED visits, liver disease increased the odds for THA patients (OR: 1.845, P = .100), and aseptic loosening, osteolysis, or instability decreased the odds for TKA patients (OR: 0.223, P < .001). Increased age was associated with increased costs in both THA and TKA patients, with significant cost factors including congestive heart failure for TKA patients (OR: $7,308.17, P = .004) and kidney disease for THA patients. Revision surgeries took longer than primary ones, with TKA averaging 3.0 hours (1.6 times longer) and THA 2.8 hours (1.5 times longer).
Liver disease increases ED readmission risk in revision THA, while aseptic loosening, osteolysis, or instability decreases it in revision TKA. Increased age and congestive heart failure are associated with increased costs. These findings inform postoperative care and resource allocation in revision arthroplasty.
Economic and Decision Analysis, Level IV.
翻修全髋关节置换术（THA）和全膝关节置换术（TKA）极大地消耗了医院资源。本研究评估了影响围手术期成本的因素，包括急诊就诊（ED）、再入院和翻修手术后 90 天内的总护理成本。
对 2007 年 1 月至 2019 年 12 月在单中心接受 772 例翻修 TKA 和 THA 的 630 名患者进行回顾性分析。277 名患者的成本数据可获得自 2015 年 1 月至 2019 年 12 月。使用混合效应线性回归模型，检查了合并症、人口统计学信息、术前麻醉医师协会评分、假体选择和手术适应证等因素。
在 772 例翻修手术中（425 例 THA 和 347 例 TKA），213 例患者需要 ED 就诊，90 例患者在 90 天内需要住院再入院。22.6%的患者在初次翻修后需要再次手术。THA 患者的肝脏疾病是 ED 再入院的显著预测因素（多变量比值比[OR]：3.473，P =.001），而无菌性松动、骨溶解或不稳定显著降低了 TKA 患者的再入院几率（OR：0.368，P =.014）。就 ED 就诊而言，肝脏疾病增加了 THA 患者的几率（OR：1.845，P =.100），而无菌性松动、骨溶解或不稳定降低了 TKA 患者的几率（OR：0.223，P <.001）。THA 和 TKA 患者年龄的增加与成本的增加有关，对 TKA 患者而言，心力衰竭是显著的成本因素（OR：7308.17 美元，P =.004），而 THA 患者的肾脏疾病是显著的成本因素。翻修手术比初次手术时间更长，TKA 平均 3.0 小时（延长 1.6 倍），THA 平均 2.8 小时（延长 1.5 倍）。
肝脏疾病增加了翻修 THA 的 ED 再入院风险，而无菌性松动、骨溶解或不稳定降低了翻修 TKA 的 ED 再入院风险。年龄的增加和充血性心力衰竭与成本的增加有关。这些发现为翻修关节置换术后的护理和资源分配提供了信息。
经济和决策分析，IV 级。
