门诊手术中心、医院门诊部和医院全关节置换术后90天结果评估：密歇根关节置换登记协作质量倡议分析。
Assessment of 90-Day Outcomes Following Total Joint Arthroplasty in Ambulatory Surgery Centers, Hospital Outpatient Departments, and Hospitals: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis.
作者信息
Puri Simarjeet, Weaver Martin, Chen Lisheng, Kim Tae, Dailey Elizabeth, Markel David C
机构信息
Section of Orthopedic Surgery, Ascension Providence Hospital, Southfield, MI, USA.
Michigan Arthroplasty Registry Collaborative Quality Initiative, Ann Arbor, MI, USA.
出版信息
Arthroplast Today. 2025 Mar 8;32:101659. doi: 10.1016/j.artd.2025.101659. eCollection 2025 Apr.
BACKGROUND
Total joint arthroplasty is shifting from hospitals to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). A Michigan Arthroplasty Registry Quality Collaborative Initiative quality improvement project examined readmissions, emergency room (ER) visits, periprosthetic joint infection (PJI), fracture, and dislocation after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) across sites.
METHODS
Primary TJAs between July 1, 2021, and June 30, 2022 (N = 41,696: 3910 ASC, 1,834 HOPD, and 35,952 hospital) were reviewed. Of 17,100 THAs, 9.5% (1,631) were at ASCs, 4.7% (798) at HOPDs, and 85.8% (14,671) at hospitals. Of 24,596 TKAs, 9.3% (2,279) were at ASC, 4.2% (1,036) at HOPDs, and 86.5% (21,281) at hospitals. Hospitals treated more elderly, women, non-White, obese, diabetics, smokers, and governmental insurance.
RESULTS
For THAs, ASCs had the lowest 30-day (ASC 1%, HOPD 1.8%, hospital 3.4%, < .001) and 90-day (ASC 1.7%, HOPD 3.4%, hospital 5.5%, < .001) readmissions, 30-day ER visits (ASC 1.8%, HOPD 3.5%, hospital 5.3%, < .001), and fractures (ASC 0.4%, HOPD 0.6%, hospital 1.2%, < .001). Similar trends were observed for TKAs: 30-day readmissions (ASC 1.3%, HOPD 1.4%, hospital 3.1%, < .001), 90-day readmissions (ASC 2.2%, HOPD 2.3%, hospital 5.2%, < .001), and 30-day ER visits (ASC 3%, HOPD 6.5%, hospital 6.4%, < .001). PJI (THA: = .1, TKA: = .6) and dislocation rates ( = .5) were similar across sites.
CONCLUSIONS
Patients receiving primary total joint arthroplasty at an ASC had the least postoperative hospital-based care despite similar rates of PJI and dislocation.
背景
全关节置换术正从医院转向门诊手术中心（ASC）和医院门诊部（HOPD）。密歇根关节置换登记质量合作倡议质量改进项目研究了全髋关节置换术（THA）或全膝关节置换术（TKA）术后在不同地点的再入院、急诊室（ER）就诊、假体周围关节感染（PJI）、骨折和脱位情况。
方法
回顾了2021年7月1日至2022年6月30日期间的初次全关节置换术（N = 41,696：3910例在ASC，1834例在HOPD，35,952例在医院）。在17,100例THA中，9.5%（1631例）在ASC，4.7%（798例）在HOPD，85.8%（14,671例）在医院。在24,596例TKA中，9.3%（2279例）在ASC，4.2%（1036例）在HOPD，86.5%（21,281例）在医院。医院治疗的患者中老年人、女性、非白人、肥胖者、糖尿病患者、吸烟者和政府保险参保者更多。
结果
对于THA，ASC的30天（ASC为1%，HOPD为1.8%，医院为3.4%，P <.001）和90天（ASC为1.7%，HOPD为3.4%，医院为5.5%，P <.001）再入院率、30天急诊室就诊率（ASC为1.8%，HOPD为3.5%，医院为5.3%，P <.001）和骨折率（ASC为0.4%，HOPD为0.6%，医院为1.2%，P <.001）最低。TKA也观察到类似趋势：30天再入院率（ASC为1.3%，HOPD为1.4%，医院为3.1%，P <.001）、90天再入院率（ASC为2.2%，HOPD为2.3%，医院为5.2%，P <.001）和30天急诊室就诊率（ASC为3%，HOPD为6.5%，医院为6.4%，P <.001）。各地点的PJI（THA：P =.1，TKA：P =.6）和脱位率（P =.5）相似。
结论
在ASC接受初次全关节置换术的患者术后接受的以医院为基础的护理最少，尽管PJI和脱位率相似。
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