The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population.

IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Journal of the Chinese Medical Association Pub Date : 2023-05-01 DOI:10.1097/JCMA.0000000000000892
Te-Feng Arthur Chou, Hsuan-Hsiao Ma, Chi-Wu Tsai, Shang-Wen Tsai, Cheng-Fong Chen, Fang-Yao Chiu, Po-Kuei Wu, Wei-Ming Chen
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Abstract

Background: In patients with advanced osteoarthritis (OA) of the bilateral knees, uncertainty remains as to whether simultaneous bilateral total knee arthroplasty (SiTKA) or staged TKA (StTKA) is the treatment of choice. The purpose of this study was to investigate the safety and relative cost of SiTKA vs StTKA in Taiwan patients.

Methods: Using the Big Data Center of Taipei Veterans General Hospital, we retrospectively reviewed all patients who underwent SiTKA or StTKA due to OA or spontaneous osteonecrosis of the knee from January 2011 to December 2016. We assessed length of stay, transfusion rate, early postoperative complications, 30- and 90-day readmission rate, 1-year reoperation rate, and the indication for reoperation. Furthermore, we analyzed the total cost of the two groups, including reimbursement from the national health insurance (NHI), cost of the procedures, and net income from each case.

Results: A total of 2016 patients (1565 SiTKA and 451 StTKA) were included in this study. The two groups had no significant differences in rates of complications, 30- and 90-day readmission, or 1-year reoperation. The length of stay was on average 5.0 days longer for StTKA ( p < 0.01). In terms of cost, all categories of medical costs were significantly lower for SiTKA, while the net hospital income was significantly higher for StTKA.

Conclusion: SiTKA is a safe and cost-effective surgery. Both SiTKA and StTKA have similar rates of postoperative complications, readmission and reoperation, but SiTKA significantly reduces medical expenses for both the patient and the NHI.

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台湾人群同时与分期双侧全膝关节置换术的安全性与成本分析。
背景:在双侧膝关节晚期骨关节炎(OA)患者中,是否选择双侧同期全膝关节置换术(SiTKA)或分期全膝关节置换术(StTKA)仍不确定。本研究的目的是探讨SiTKA与StTKA在台湾患者中的安全性和相对成本。方法:利用台北退伍军人总医院大数据中心,回顾性分析2011年1月至2016年12月所有因OA或自发性膝骨坏死行SiTKA或StTKA的患者。我们评估住院时间、输血率、术后早期并发症、30天和90天再入院率、1年再手术率和再手术指征。此外,我们分析了两组的总成本,包括国民健康保险(NHI)的报销、手术成本和每个病例的净收入。结果:共纳入2016例患者(SiTKA 1565例,StTKA 451例)。两组患者并发症发生率、30天、90天再入院率、1年再手术率无显著差异。StTKA患者住院时间平均延长5.0 d (p < 0.01)。在成本方面,SiTKA的所有类别的医疗费用都明显较低,而StTKA的医院净收入则明显较高。结论:SiTKA是一种安全、经济的手术。SiTKA和StTKA的术后并发症、再入院和再手术率相似,但SiTKA显著降低了患者和国家医疗保健中心的医疗费用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of the Chinese Medical Association
Journal of the Chinese Medical Association MEDICINE, GENERAL & INTERNAL-
CiteScore
6.20
自引率
13.30%
发文量
320
审稿时长
15.5 weeks
期刊介绍: Journal of the Chinese Medical Association, previously known as the Chinese Medical Journal (Taipei), has a long history of publishing scientific papers and has continuously made substantial contribution in the understanding and progress of a broad range of biomedical sciences. It is published monthly by Wolters Kluwer Health and indexed in Science Citation Index Expanded (SCIE), MEDLINE®, Index Medicus, EMBASE, CAB Abstracts, Sociedad Iberoamericana de Informacion Cientifica (SIIC) Data Bases, ScienceDirect, Scopus and Global Health. JCMA is the official and open access journal of the Chinese Medical Association, Taipei, Taiwan, Republic of China and is an international forum for scholarly reports in medicine, surgery, dentistry and basic research in biomedical science. As a vehicle of communication and education among physicians and scientists, the journal is open to the use of diverse methodological approaches. Reports of professional practice will need to demonstrate academic robustness and scientific rigor. Outstanding scholars are invited to give their update reviews on the perspectives of the evidence-based science in the related research field. Article types accepted include review articles, original articles, case reports, brief communications and letters to the editor
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