Cole Sarah, Peri Maria, Whitaker Sarah, Ernst Brady, O'Neill Conor, Satalich James, Vap Alexander
Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA.
J Orthop. 2024 Aug 28;60:44-50. doi: 10.1016/j.jor.2024.08.016. eCollection 2025 Feb.
Provided that total hip arthroplasties (THA) are some of the most common surgical procedures performed, there is a necessity to understand all factors that contribute to risks of adverse outcomes postoperatively and to find solutions to avoid these events with preventive measures. This retrospective cohort study sought to assess differences in (1) postoperative complication rates, (2) readmission rates and reasons, and (3) demographic variables that contribute to readmissions based on discharge destination within the first 30 days after a THA.
Patients undergoing THA (27130) between 2015 and 2020 were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database based on procedural codes. Propensity score matching was then employed to reduce selection bias, and Chi-square tests and one-way analysis of variance (ANOVA) were performed. Multivariable analysis was then used to look for other factors associated with readmission risk.
219,960 patients were identified with 189,841 discharged to home, 19,355 to a skilled nursing facility (SNF), and 10,764 to a rehabilitation facility. The rehabilitation and SNF cohorts both had greater rates of readmission (4.56 % home vs. 6.88 % SNF vs. 6.90 % rehabilitation, P<0.001) and any adverse event (AAE, 9.02 % vs. 18 % vs. 21.3 %, P<0.001) after matching. Older age, longer operative time, American Society of Anesthesiologists (ASA) classification four, chronic obstructive pulmonary disease (COPD), bleeding disorders, steroid use, and smoking were associated with an increased risk of readmission after THA.
Overall, THAs were shown to have low postoperative complications and readmissions in all patient populations despite differences in discharge destination which continues to demonstrate the safety and validity of this often elective procedure. However, the statistically significant risk of complications and readmissions in addition to the higher costs associated should be accounted for when considering patient discharges to a non-home facility.
鉴于全髋关节置换术（THA）是最常见的外科手术之一，有必要了解所有导致术后不良结局风险的因素，并找到通过预防措施避免这些事件的解决方案。这项回顾性队列研究旨在评估（1）术后并发症发生率、（2）再入院率及原因，以及（3）基于THA后30天内出院目的地导致再入院的人口统计学变量的差异。
根据手术编码，从美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中提取2015年至2020年间接受THA的患者（27130例）。然后采用倾向得分匹配以减少选择偏倚，并进行卡方检验和单因素方差分析（ANOVA）。随后使用多变量分析寻找与再入院风险相关的其他因素。
共识别出219960例患者，其中189841例出院回家，19355例入住专业护理机构（SNF）, 以及10764例入住康复机构。匹配后，康复机构队列和SNF队列的再入院率（出院回家为4.56%，SNF为6.88%，康复机构为6.90%，P<0.001）和任何不良事件（AAE，分别为9.02%、18%和21.3%，P<0.001）均更高。年龄较大、手术时间较长、美国麻醉医师协会（ASA）分级为四级、慢性阻塞性肺疾病（COPD）、出血性疾病、使用类固醇和吸烟与THA后再入院风险增加相关。
总体而言，尽管出院目的地存在差异，但所有患者群体的THA术后并发症和再入院率均较低，这继续证明了这种通常为择期手术的安全性和有效性。然而，在考虑将患者出院至非家庭机构时应考虑到并发症和再入院的统计学显著风险以及相关的较高成本。
