From Sunnybrook Health Sciences Centre (Diaz-Dilernia, Steinfeld, Pincus, Ravi), Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont.; Division of Orthopedic Surgery (Diaz-Dilernia), Department of Surgery, Kingston General Hospital, Kingston Health Sciences Centre, Queen's University, Kingston, Ont.; Mayo Clinic Arizona (Spangehl), Phoenix, Ariz.; ICES Central (Ravi), Toronto, Ont.
Can J Surg. 2024 Nov 26;67(6):E377-E382. doi: 10.1503/cjs.004724. Print 2024 Nov-Dec.
Follow-up protocols after total hip or knee arthroplasty (THA or TKA, respectively) have little uniformity, which can lead to emergency department (ED) visits for postoperative complications. We sought to determine the incidence and timing of postoperative complications after THA or TKA.
We conducted a population-based retrospective cohort study of all adults in Ontario who underwent primary THA or TKA between 2010 and 2019. We used data available through ICES. We identified medical and surgical complications, ED visits, and hospital readmissions using institutional databases and Ontario Health Insurance Plan claims. Outcomes included major medical complications within 30 days and surgical complications within 1 year after surgery.
We included 158 503 and 103 728 patients who underwent TKA and THA, respectively. The incidence of medical complications within 30 days was 2.90% after TKA and 2.42% after THA. Visits to the ED (20.0% after TKA, 16.9% after THA) and readmission rates within 30 days (3.8% after TKA, 4.1% after THA) were similar for both groups. Visits to the ED occurred at a median of 10 days after surgery for both groups, with readmissions at a median of 12 and 13 days after TKA and THA, respectively. The incidence of major TKA complications was 1.6%, with a median time of 84 (interquartile range [IQR] 26-224) days. The incidence of major THA complications was 2.2%, with a median time of 29 (IQR 16-80) days.
Our findings suggest follow-up contact 7-10 days after THA or TKA to minimize ED visits, with at least 1 subsequent in-person follow-up at 5-6 weeks after surgery. After that, surgeons may personalize additional follow-ups as needed.
全髋关节或全膝关节置换术（分别为 THA 或 TKA）后的随访方案缺乏一致性，这可能导致术后并发症患者前往急诊部（ED）就诊。我们旨在确定 THA 或 TKA 后术后并发症的发生率和发生时间。
我们对 2010 年至 2019 年间在安大略省接受初次 THA 或 TKA 的所有成年人进行了一项基于人群的回顾性队列研究。我们使用通过安大略省综合卫生信息网络（ICES）获得的数据。我们通过机构数据库和安大略省医疗保险计划（OHIP）索赔识别医疗和手术并发症、ED 就诊和医院再入院。结局包括术后 30 天内的主要医疗并发症和术后 1 年内的手术并发症。
我们纳入了分别接受 TKA 和 THA 的 158503 例和 103728 例患者。TKA 术后 30 天内医疗并发症的发生率为 2.90%，THA 为 2.42%。两组 ED 就诊率（TKA 为 20.0%，THA 为 16.9%）和术后 30 天内再入院率（TKA 为 3.8%，THA 为 4.1%）相似。两组 ED 就诊中位时间均为术后 10 天，再入院中位时间分别为 TKA 和 THA 术后 12 天和 13 天。TKA 主要并发症的发生率为 1.6%，中位时间为 84 天（四分位距 [IQR] 26-224）。THA 主要并发症的发生率为 2.2%，中位时间为 29 天（IQR 16-80）。
我们的研究结果表明，THA 或 TKA 后 7-10 天进行随访接触，以尽量减少 ED 就诊，术后 5-6 周至少进行 1 次面对面随访。之后，外科医生可根据需要个性化安排其他随访。
