Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois.
Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Arthroplasty. 2024 Dec;39(12):3036-3040. doi: 10.1016/j.arth.2024.06.020. Epub 2024 Jun 17.
Outpatient primary total knee arthroplasty (TKA) has been well-established as a safe and effective procedure; however, the safety of outpatient revision TKA remains unclear. Therefore, this study utilized a large database to compare outcomes between outpatient and inpatient revision TKA.
An all-payor database was queried to identify patients undergoing revision TKA from 2010 to 2022. Patients who had diagnosis codes related to periprosthetic joint infection (PJI) were excluded. Outpatient surgery was defined as a length of stay < 24 hours. Cohorts were matched by age, sex, Elixhauser Comorbidity Index, comorbidities (diabetes, obesity, tobacco use), components revised (1-versus 2-component), and revision etiology. Medical complications at 90 days and surgical complications at 1 and 2 years postoperatively were evaluated through multivariate logistic regression. A total of 4,342 aseptic revision TKAs were included.
No differences in patient characteristics, procedure type, or revision etiologies were seen between groups. The outpatient cohort had a lower risk of PJI (odds ratio (OR): 0.547, 95% confidence interval (CI): 0.337 to 0.869; P = .012), wound dehiscence (OR: 0.393, 95% CI: 0.225 to 0.658; P < .001), transfusion (OR: 0.241, 95% CI: 0.055 to 0.750; P = .027), reoperation (OR: 0.508, 95% CI: 0.305 to 0.822; P = .007), and any complication (OR: 0.696, 95% CI: 0.584 to 0.829; P < .001) at 90 days postoperatively. At 1 year and 2 years postoperatively, outpatient revision TKA patients had a lower incidence of revision for PJI (OR: 0.332, 95% CI: 0.131 to 0.743; P = .011 and OR: 0.446, 95% CI; 0.217 to 0.859; P = .020, respectively) and all-cause revision (OR: 0.518, 95% CI: 0.377 to 0.706; P < .001 and OR: 0.548, 95% CI: 0.422 to 0.712; P < .001, respectively).
Our findings suggest that revision TKA can be safely performed on an outpatient basis in appropriately selected patients who do not have an increased risk of adverse events relative to inpatient revision TKA. However, we could not ascertain case complexity in either cohort, and despite controlling for several potential confounders, other less tangible differences could exist between groups.
门诊初次全膝关节置换术（TKA）已被证明是一种安全有效的手术方法；然而，门诊翻修 TKA 的安全性仍不清楚。因此，本研究利用大型数据库比较了门诊和住院翻修 TKA 的结果。
通过全付费数据库，确定了 2010 年至 2022 年期间接受翻修 TKA 的患者。排除有假体周围关节感染（PJI）诊断代码的患者。门诊手术的定义为住院时间<24 小时。通过年龄、性别、Elixhauser 合并症指数、合并症（糖尿病、肥胖、吸烟）、修订的组件（1 组件与 2 组件）和修订病因，对患者进行匹配。通过多变量逻辑回归评估术后 90 天的医疗并发症和术后 1 年和 2 年的手术并发症。共纳入 4342 例无菌性翻修 TKA。
两组患者的一般特征、手术类型或翻修病因均无差异。门诊组 PJI（比值比（OR）：0.547，95%置信区间（CI）：0.337 至 0.869；P=0.012）、伤口裂开（OR：0.393，95%CI：0.225 至 0.658；P<0.001）、输血（OR：0.241，95%CI：0.055 至 0.750；P=0.027）、再次手术（OR：0.508，95%CI：0.305 至 0.822；P=0.007）和任何并发症（OR：0.696，95%CI：0.584 至 0.829；P<0.001）的风险较低术后 90 天。术后 1 年和 2 年，门诊翻修 TKA 患者的 PJI（OR：0.332，95%CI：0.131 至 0.743；P=0.011 和 OR：0.446，95%CI：0.217 至 0.859；P=0.020）和全因翻修（OR：0.518，95%CI：0.377 至 0.706；P<0.001 和 OR：0.548，95%CI：0.422 至 0.712；P<0.001）的发生率较低。
我们的研究结果表明，在适当选择的患者中，门诊翻修 TKA 是安全的，与住院翻修 TKA 相比，这些患者发生不良事件的风险没有增加。然而，我们无法确定任何队列中的病例复杂性，尽管我们控制了几个潜在的混杂因素，但两组之间可能存在其他无形的差异。
