Plancher Kevin D, Mannina Carlo M, Schwartz Elias N, Briggs Karen K, Petterson Stephanie C
Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York; Plancher Orthopaedics & Sports Medicine, New York, New York; Orthopaedic Foundation, Stamford, Connecticut.
Plancher Orthopaedics & Sports Medicine, New York, New York.
J Arthroplasty. 2025 Sep;40(9S1):S315-S319. doi: 10.1016/j.arth.2025.04.025. Epub 2025 Apr 11.
With the rise in outpatient elective surgery, the safety of revision total knee arthroplasty (TKA) as an outpatient procedure has been questioned. This study compared surgical outcomes and complications of inpatient versus outpatient revision TKA using a large national database.
The database was queried for patients who underwent outpatient and inpatient revision TKA. Groups were propensity-matched by age, sex, one or two-component revision, and the Elixhauser Comorbidity Index, resulting in 7,728 patients per group. Outcome measures included 2-year re-revision, 90-day hospital readmission, manipulation under anesthesia, and 6-month medical complications. Queries were based on Current Procedural Terminology and International Classification of Diseases codes. Binomial logistic regression was used to determine predictors of failure.
Hospital readmissions were higher in the inpatient revision TKA group (P < 0.001). The inpatient group had higher rates of blood transfusion (odds ratio (OR): 2.0 (1.6 to 2.5) P < 0.001), deep vein thrombosis (OR: 1.8 (1.1 to 2.8) P = 0.02), pulmonary embolism (OR: 2.7 (1.7 to 4.2) P < 0.001), acute kidney injury (OR: 1.5 (1.3 to 1.8) P < 0.001), and periprosthetic joint infection (OR: 1.5 (1.4 to 1.7), P < 0.001). Independent predictors of failure in the inpatient group were age (P < 0.001), two-component revision (OR: 3.7 (3.1 to 4.4) P < 0.001), and infection (OR: 3.9 (3.3 to 4.7) P < 0.001) and in the outpatient group were age (P < 0.001), Elixhauser Comorbidity Index (P = 0.03), two-component revision (OR: 4.2 (3.6 to 5.0) P < 0.001), and infection (OR: 3.9 (3.2 to 4.7) P < 0.001).
Outpatient revision TKA did not carry a higher risk of medical complications, hospital readmissions, or re-revision. Inpatient revision TKA had a higher incidence of medical complications. While inpatient care remains important for patients with complex medical conditions, outpatient revision TKA is a safe and effective option in appropriately-selected patients.
随着门诊择期手术的增加，作为门诊手术的全膝关节置换翻修术（TKA）的安全性受到质疑。本研究使用一个大型国家数据库比较了住院与门诊TKA翻修术的手术结果和并发症。
在数据库中查询接受门诊和住院TKA翻修术的患者。根据年龄、性别、单组件或双组件翻修以及埃利克斯豪泽合并症指数对两组进行倾向匹配，每组有7728例患者。结果指标包括2年再次翻修、90天内再次入院、麻醉下手法操作以及6个月内的医疗并发症。查询基于当前手术操作术语和国际疾病分类代码。使用二项逻辑回归确定失败的预测因素。
住院TKA翻修术组的再次入院率更高（P<0.001）。住院组输血率更高（比值比（OR）：2.0（1.6至2.5），P<0.001）、深静脉血栓形成（OR：1.8（1.1至2.8），P=0.02）、肺栓塞（OR：2.7（1.7至4.2），P<0.001）、急性肾损伤（OR：1.5（1.3至1.8），P<0.001）和假体周围关节感染（OR：1.5（1.4至1.7），P<0.001）。住院组失败的独立预测因素为年龄（P<0.001）、双组件翻修（OR：3.7（3.1至4.4），P<0.001）和感染（OR：3.9（3.3至4.7），P<0.001），门诊组为年龄（P<0.001）、埃利克斯豪泽合并症指数（P=0.03）、双组件翻修（OR：4.2（3.6至5.0），P<0.001）和感染（OR：3.9（3.2至4.7），P<0.001）。
门诊TKA翻修术不会带来更高的医疗并发症、再次入院或再次翻修风险。住院TKA翻修术的医疗并发症发生率更高。虽然对于患有复杂疾病的患者，住院治疗仍然很重要，但门诊TKA翻修术对于适当选择的患者是一种安全有效的选择。
