Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois; Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois.
J Surg Orthop Adv. 2024 Summer;33(2):61-67.
Rural patients have poorer health indicators, including higher risk of developing osteoarthritis. The objective of this study is to compare rural patients undergoing primary total joint arthroplasty (TJA) at rural hospitals with those undergoing primary TJA at urban hospitals with regards to demographics, comorbidities, and complications and to determine the preferred location of care for rural patients. Data from the Healthcare Cost and Utilization Project National Inpatient Sample between 2016 and 2018 were analyzed. Demographics, comorbidities, inpatient complications, hospital length of stay, inpatient mortality, and discharge disposition were compared between rural patients who underwent TJA at rural hospitals and urban hospitals. Rural patients undergoing primary TJA in rural hospitals were more likely to be women, to be treated in the South, to have Medicaid payer status, to have dementia, diabetes mellitus, lung disease, and postoperative pulmonary complications, and to have a longer hospital length of stay. Those patients were also less likely to have baseline obesity, heart disease, kidney disease, liver disease, cancer, postoperative infection, and cardiovascular complications, and were less likely to be discharged home. Rural patients undergoing primary TJA tend to pursue surgery in their rural hospital when their comorbidity profile is manageable. These patients get their surgery performed in an urban setting when they have the means for travel and cost, and when their comorbidity profile is more complicated, requiring more specialized care, Rural patients are choosing to undergo their primary TJA in urban hospitals as opposed to their local rural hospitals. (Journal of Surgical Orthopaedic Advances 33(2):061-067, 2024).
农村患者的健康指标较差，包括患骨关节炎的风险较高。本研究旨在比较在农村医院接受初次全关节置换术（TJA）的农村患者和在城市医院接受初次 TJA 的农村患者的人口统计学、合并症和并发症，并确定农村患者的首选治疗地点。分析了 2016 年至 2018 年期间医疗保健成本和利用项目国家住院患者样本的数据。比较了在农村医院和城市医院接受 TJA 的农村患者的人口统计学、合并症、住院并发症、住院时间、住院死亡率和出院去向。在农村医院接受初次 TJA 的农村患者更可能是女性，更可能在南部地区接受治疗，更可能有医疗补助支付者身份，更可能患有痴呆症、糖尿病、肺部疾病和术后肺部并发症，住院时间更长。这些患者也不太可能患有基线肥胖症、心脏病、肾病、肝病、癌症、术后感染和心血管并发症，出院回家的可能性也较低。农村患者在可管理其合并症特征时，倾向于在其农村医院接受手术。当这些患者有旅行和费用的手段，并且当他们的合并症特征更复杂，需要更专业的治疗时，他们会选择在城市医院接受手术。农村患者选择在城市医院而不是当地农村医院接受初次 TJA。（《手术矫形进展杂志》33(2):061-067, 2024）。
