Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Arthroplasty. 2024 Nov;39(11):2837-2840.e1. doi: 10.1016/j.arth.2024.05.047. Epub 2024 May 24.
Recent studies have focused on the safety and efficacy of performing primary total knee arthroplasty (TKA) in an outpatient setting. Despite being associated with greater costs, much less is known about the accompanying impact on revision TKA (rTKA). The purpose of this study was to describe the trends in costs and outcomes of patients undergoing inpatient and outpatient rTKA.
An observational cohort study was conducted using commercial claims databases. Patients who underwent 1-component and 2-component rTKA in an inpatient setting, hospital outpatient department (HOPD), or ambulatory surgery center (ASC) from 2018 to 2020 were included. The primary outcome was the 30-day episode-of-care costs following rTKA. Secondary outcomes included surgical cost, 90-day readmission rate, and emergency department visit rate. Covariates for analyses included patient demographics, surgery type, and indication for revision.
There were 6,515 patients who were identified, with 17.0% of rTKAs taking place in an outpatient setting. On adjusted analysis, patients in the highest quartile of 30-day postoperative costs were more likely to be those whose rTKA was performed in an inpatient setting. One-component revisions were more common in an outpatient setting (HOPD, 50.7%; ASC, 62.0%) compared to an inpatient setting (39.6%). The 90-day readmission rates were higher (P = .003) for rTKAs performed in inpatient (+9.2%) and HOPD (+8.6%) settings compared to those in an ASC.
The ASC may be a suitable setting for simpler revisions performed for less severe indications and is associated with lower costs and 90-day readmission and emergency department visit rates.
最近的研究集中在门诊环境下进行初次全膝关节置换术（TKA）的安全性和有效性。尽管它与更高的成本相关，但对于随之而来的翻修 TKA（rTKA）的影响知之甚少。本研究的目的是描述接受住院和门诊 rTKA 的患者的成本和结果趋势。
使用商业索赔数据库进行观察性队列研究。纳入 2018 年至 2020 年在住院、医院门诊（HOPD）或门诊手术中心（ASC）接受单组件和双组件 rTKA 的患者。主要结局是 rTKA 后 30 天的医疗护理成本。次要结局包括手术成本、90 天再入院率和急诊就诊率。分析的协变量包括患者人口统计学、手术类型和翻修指征。
共确定了 6515 名患者，其中 17.0%的 rTKA 在门诊进行。在调整后的分析中，术后 30 天费用最高四分位数的患者更有可能在住院环境下接受 rTKA。单组件翻修在门诊环境（HOPD，50.7%；ASC，62.0%）比住院环境（39.6%）更常见。在住院（+9.2%）和 HOPD（+8.6%）环境下进行 rTKA 的 90 天再入院率更高（P =.003）。
ASC 可能是更简单的翻修的合适场所，适用于较轻的指征，并且与较低的成本以及 90 天再入院和急诊就诊率相关。
