Diep Calvin, Jaffe Rachael, Witiw Christopher, Daza Julian F, Wijeysundera Duminda N, Ravi Bheeshma, Ladha Karim S
Department of Anesthesiology & Pain Medicine, University of Toronto, 123 Edward St (12th Floor), Toronto, ON, M5G 0A8, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2025 May 12. doi: 10.1007/s12630-025-02960-0.
Postoperative complications can steer patients away from a typical surgical recovery trajectory and hinder their ability to work and earn income. We aimed to quantify these effects for working-aged adults after elective joint replacement surgery.
We conducted a population-based cohort study of adults aged 30-63 yr having elective hip or knee arthroplasty using the Canadian Hospitalization and Taxation Database from 2004 to 2019. Our primary exposure was a postoperative complication, defined as a composite of adverse medical events, intensive care unit visit, or rehospitalization within thirty days. Our coprimary outcomes were employment and earnings in the second calendar year after surgery. We matched patients with complications 1:1 to those without complications using a propensity score considering demographic, medical, and financial characteristics. We used probit regression to assess employment after surgery and difference-in-difference ordinary least squares regression for the change in earnings from before to after surgery.
We included 222,087 adults undergoing an elective hip or knee replacement. In total, 6.3% experienced postoperative complications. In the second year after surgery, 55.1% of patients with complications were working compared with 57.3% of patients without complications (-2.2 percentage points [pp], 95% confidence interval [CI], -3.5 to -1.0). Patients with complications had a CAD 1,782 greater decline in annual earnings from before surgery (95% CI, -2,775 to -789; values inflated to 2023 Canadian dollars) than patients without complications.
Postoperative complications resulted in a lower likelihood of employment and lower earnings after elective hip or knee replacement surgery. This may also have broader economic implications.
术后并发症可能使患者偏离典型的手术康复轨迹，并阻碍其工作和赚取收入的能力。我们旨在量化择期关节置换手术后对劳动年龄成年人的这些影响。
我们利用2004年至2019年加拿大住院和税收数据库，对30至63岁接受择期髋关节或膝关节置换术的成年人进行了一项基于人群的队列研究。我们的主要暴露因素是术后并发症，定义为不良医疗事件、重症监护病房就诊或术后30天内再次住院的综合情况。我们的共同主要结局是手术后第二个日历年的就业情况和收入。我们使用倾向评分，根据人口统计学、医学和财务特征，将有并发症的患者与无并发症的患者按1:1进行匹配。我们使用概率回归评估术后就业情况，并使用差分普通最小二乘回归评估手术前后收入的变化。
我们纳入了222,087名接受择期髋关节或膝关节置换的成年人。总共有6.3%的人经历了术后并发症。在术后第二年，有并发症的患者中有55.1%在工作，而无并发症的患者中这一比例为57.3%（相差-2.2个百分点[pp]，95%置信区间[CI]，-3.5至-1.0）。与无并发症的患者相比，有并发症的患者术后年收入下降幅度比前者多1782加元（95%CI，-2775至-789；价值按2023年加拿大元进行了通胀调整）。
术后并发症导致择期髋关节或膝关节置换手术后就业可能性降低和收入减少。这也可能产生更广泛的经济影响。
