Portnoy Antoinette R, Chen Shirley, Tabbaa Ameer, Magruder Matthew L, Kang Kevin, Razi Afshin E
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Hip Pelvis. 2024 Sep 1;36(3):204-210. doi: 10.5371/hp.2024.36.3.204.
The purpose of this study was to determine whether the rates of (1) in-hospital lengths of stay (LOS), (2) readmissions, (3) medical complications, and (4) costs of care are higher for patients with depressive disorder (DD) undergoing primary total hip arthroplasty (THA) for treatment of femoral neck fractures (FNFs).
A retrospective query of a national administrative claims database for patients undergoing primary THA from 2006 to 2014 was conducted. Patients with DD undergoing THA for treatment of FNF were 1:5 ratio propensity score matched to a cohort (DD=6,758, controls=33,708). Primary endpoints included LOS, 90-day medical complications, 90-day readmissions, and healthcare reimbursements. A -value less than 0.05 was considered statistically significant.
Longer LOS were observed for patients with DD compared to those without DD (5.6 days vs. 5.4 days, <0.001). Similar readmission rates (29.9% vs. 25.0%, odds ratio [OR] 1.03, =0.281) were observed between groups. The odds of 90-day medical complications were higher for patients with DD compared to control subjects (60.6% vs. 21.4%, OR 1.57, <0.0001). Within the 90-day episode of care interval, patients with a history of DD incurred significantly higher healthcare expenditures ($21,382 vs. $19,781, <0.001).
Our findings showed longer LOS, higher odds of 90-day medical complications, and higher healthcare expenditures within the 90-day episode of care following a primary THA for treatment of FNF for patients with DD compared to the matched cohort. Thus, accordingly, patients with DD should receive counseling prior to undergoing surgery.
本研究旨在确定因股骨颈骨折（FNF）接受初次全髋关节置换术（THA）的抑郁症（DD）患者在（1）住院时间（LOS）、（2）再入院率、（3）医疗并发症及（4）护理费用方面是否更高。
对2006年至2014年接受初次THA的患者的国家行政索赔数据库进行回顾性查询。因FNF接受THA的DD患者与队列进行1:5比例的倾向评分匹配（DD = 6758例，对照组 = 33708例）。主要终点包括LOS、90天医疗并发症、90天再入院率及医疗费用报销。P值小于0.05被认为具有统计学意义。
与无DD的患者相比，DD患者的LOS更长（5.6天对5.4天，P < 0.001）。两组间观察到相似的再入院率（29.9%对25.0%，优势比[OR] 1.03，P = 0.281）。与对照组相比，DD患者发生90天医疗并发症的几率更高（60.6%对21.4%，OR 1.57，P < 0.0001）。在90天护理期间，有DD病史的患者产生的医疗费用显著更高（21382美元对19781美元，P < 0.001）。
我们的研究结果表明，与匹配队列相比，因FNF接受初次THA治疗的DD患者在90天护理期间LOS更长，发生90天医疗并发症的几率更高，医疗费用也更高。因此，DD患者在手术前应接受咨询。
