Howell Cole, Witvoet Sietske, Scholl Laura, Coppolecchia Andrea, Bhowmik-Stoker Manoshi, Chen Antonia F
Albany Medical College, Albany, NY.
Stryker, Amsterdam, The Netherlands.
Med Care. 2025 Jul 1;63(7):465-471. doi: 10.1097/MLR.0000000000002082. Epub 2024 Oct 24.
This study aims to compare 90-day postoperative complications, readmissions, and emergency department (ED) visits between robotic-assisted (RA-THA) and manual (M-THA) total hip arthroplasty.
A retrospective review of a multi-hospital database identified primary total hip arthroplasty patients between January 2016 and December 2021. The cohorts were 1-to-1 matched based on patient sex, age, and body mass index resulting in 8033 patients in each cohort (N = 16,066). Odds of 90-day revisits, readmission with >23 hours of observation, and ED visits were compared between cohorts. Complications reported during revisits and readmission were classified according to the Clinical Classification Software schema, using the International Classification of Diseases, 10th Revision codes, and compared using mixed-effect models.
This study found an overall 90-day revisit rate of 8.3%. RA-THA was associated with significantly reduced odds of revisit within 90 days [odds ratio (OR): 0.71, 95% CI: 0.58-0.89, P = 0.002] and readmissions with >23 hours of observation (OR: 0.61, 95% CI: 0.48-0.77, P < 0.001). RA-THA patients had fewer readmissions with >23 hours of observation due to dislocations (RA-THA: 0.09%; M-THA: 0.39%, P < 0.001), surgical site infections (RA-THA: 0.04%; M-THA: 0.20%, P = 0.004), and wound infections/cellulitis (RA-THA: 0.01%; M-THA: 0.11%, P = 0.021). No difference in ED visits was observed between cohorts (OR: 0.92, 95% CI: 0.77-1.09, P = 0.3). RA-THA patients had more ED visits for dyspnea without pulmonary embolism (RA-THA: 0.20%; M-THA: 0.06%, P = 0.03).
RA-THA showed significantly lower odds of overall 90-day revisit rates and readmissions with >23 hours of observation, most notably for readmissions due to dislocation and surgical site infection/wound infections. There was no significant difference in the odds of ED visits between cohorts.
本研究旨在比较机器人辅助全髋关节置换术（RA-THA）和人工全髋关节置换术（M-THA）术后90天的并发症、再入院情况和急诊科就诊情况。
对一个多医院数据库进行回顾性分析，确定2016年1月至2021年12月期间的初次全髋关节置换术患者。根据患者性别、年龄和体重指数对队列进行1:1匹配，每个队列有8033名患者（N = 16,066）。比较队列之间90天再次就诊、观察超过23小时后再入院和急诊科就诊的几率。根据临床分类软件模式，使用国际疾病分类第10版编码对再次就诊和再入院期间报告的并发症进行分类，并使用混合效应模型进行比较。
本研究发现总体90天再次就诊率为8.3%。RA-THA与90天内再次就诊几率显著降低相关[比值比（OR）：0.71，95%置信区间（CI）：0.58-0.89，P = 0.002]，以及观察超过23小时后再入院几率降低相关（OR：0.61，95% CI：0.48-0.77，P < 0.001）。RA-THA患者因脱位导致观察超过23小时后再入院的情况较少（RA-THA：0.09%；M-THA：0.39%，P < 0.001），手术部位感染（RA-THA：0.04%；M-THA：0.20%，P = 0.004），以及伤口感染/蜂窝织炎（RA-THA：0.01%；M-THA：0.11%，P = 0.021）。队列之间急诊科就诊情况无差异（OR：0.92，95% CI：0.77-1.09，P = 0.3）。RA-THA患者因无肺栓塞的呼吸困难而进行急诊科就诊的情况更多（RA-THA：0.20%；M-THA：0.06%，P = 0.03）。
RA-THA显示总体90天再次就诊率和观察超过23小时后再入院几率显著降低，最明显的是因脱位和手术部位感染/伤口感染导致的再入院情况。队列之间急诊科就诊几率无显著差异。
