加拿大安大略省移民身份与全膝关节置换术结局的相关性：基于人群的匹配队列研究。
Association between immigration status and total knee arthroplasty outcomes in Ontario, Canada: a population-based matched cohort study.
机构信息
From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker).
出版信息
Can J Surg. 2024 May 10;67(3):E228-E235. doi: 10.1503/cjs.013723. Print 2024 May-Jun.
BACKGROUND
Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients.
METHODS
We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario. Cohorts were defined as Canadian-born or immigrants and refugees. We assessed change in yearly TKA utilization for trend. We compared differences in 1-year revision, infection rates, 30-day venous thromboembolism (VTE), presentation to emergency department, and hospital readmission between matched Canadian-born and immigrant and refugee groups.
RESULTS
We included 158 031 TKA procedures. A total of 11 973 (7.6%) patients were in the immigrant and refugee group, and 146 058 (92.4%) patients were in the Canadian-born group. The proportion of TKAs in Ontario performed among immigrants and refugees nearly doubled over the 10-year study period ( < 0.001). After matching, immigrants were at relatively lower risk of 1-year revision (0.9% v. 1.6%, < 0.001), infection ( < 0.001), death ( = 0.004), and surgical complications ( < 0.001). No differences were observed in rates of 30-day VTE or length of hospital stay. Immigrants were more likely to be discharged to rehabilitation ( < 0.001) and less likely to present to the emergency department ( < 0.001) than Canadian-born patients.
CONCLUSION
Compared with Canadian-born patients, immigrants and refugees have favourable surgical outcomes and similar rates of resource utilization after TKA. We observed an underutilization of these procedures in Ontario relative to their proportion of the population. This may reflect differences in perceptions of chronic pain or barriers accessing arthroplasty.
背景
移民和难民在使用医疗保健系统来治疗严重关节炎时面临着独特的挑战，这是由于他们对手术选择不熟悉、缺乏认识或无法获得。本研究的目的是评估与加拿大出生的患者相比，移民和难民接受全膝关节置换术（TKA）的比例、手术结果和医院利用率。
方法
我们纳入了 2011 年 1 月至 2020 年 12 月在安大略省接受初次 TKA 的所有成年人。队列定义为加拿大出生或移民和难民。我们评估了每年 TKA 利用率的变化趋势。我们比较了匹配的加拿大出生和移民及难民组之间 1 年翻修、感染率、30 天静脉血栓栓塞（VTE）、急诊就诊和住院再入院的差异。
结果
我们纳入了 158031 例 TKA 手术。共有 11973 例（7.6%）患者为移民和难民组，146058 例（92.4%）患者为加拿大出生组。在 10 年的研究期间，安大略省 TKA 的比例几乎翻了一番（<0.001）。匹配后，移民发生 1 年翻修的风险相对较低（0.9%对 1.6%，<0.001）、感染（<0.001）、死亡（=0.004）和手术并发症（<0.001）。30 天 VTE 或住院时间无差异。与加拿大出生的患者相比，移民更有可能被转至康复机构（<0.001），而较少去急诊（<0.001）。
结论
与加拿大出生的患者相比，移民和难民在接受 TKA 后手术结果较好，资源利用率相似。我们观察到安大略省这些手术的使用率相对低于其人口比例。这可能反映了对慢性疼痛的认知差异或关节置换术的获取障碍。
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