David E DeMik, Christopher N Carender, Qiang An, John J Callaghan, Timothy S Brown, Nicholas A Bedard
{"title":"全膝关节置换术后住院时间越长,早期并发症越多。","authors":"David E DeMik, Christopher N Carender, Qiang An, John J Callaghan, Timothy S Brown, Nicholas A Bedard","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Length of stay (LOS) following total knee arthroplasty (TKA) has decreased over recently years. In 2018, the Centers for Medicare and Medicaid Services removed TKA from Inpatient-Only List (IPO), incentivizing further expansion of outpatient TKA. However, many patients may still require postsurgical hospitalization. The purpose of this study was to assess early outcomes for TKA based on length of stay (LOS).</p><p><strong>Methods: </strong>We identified patients undergoing elective, primary TKA in the National Surgical Quality Improvement Program database using CPT code 27447 between 2015 and 2018. Patients were stratified by length of stay (LOS) 0 days, 1-2 days, and ≥3 days. Thirty-day rates of any complication, wound complications, readmission, and reoperation were assessed. Multivariate analysis was performed to adjust for confounding variables.</p><p><strong>Results: </strong>5,655 (3%) patients underwent outpatient TKA, 130,543 (59%) had LOS 1-2 days, and 84,986 (38%) had LOS ≥3 days. Any complication was experienced in 4.1% of those with LOS 0 days, 4.3% for those with LOS of 1-2 days, and 10.5% for patients with LOS ≥3 days (p<0.0001). Readmission occurred in 2.2%, 2.6%, and 4.0% for the 3 groups, respectively (p<0.0001). After multivariate analysis, there was no significant difference in any outcome measure between patients with LOS 0 and 1-2 days, however those with LOS ≥3 days had higher odds of complications, reoperation, and readmission.</p><p><strong>Conclusion: </strong>A significant number of patients had LOS ≥3 days following TKA and had more comorbidities and complications. Outpatient TKA was not associated with increased early complication compared to those with LOS of 1-2 days. Despite expansion of outpatient surgery, postsurgical hospitalization remains an integral part of care following TKA. <b>Level of Evidence: III</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769343/pdf/IOJ-2022-053.pdf","citationCount":"0","resultStr":"{\"title\":\"Longer Length of Stay Is Associated With More Early Complications After Total Knee Arthroplasty.\",\"authors\":\"David E DeMik, Christopher N Carender, Qiang An, John J Callaghan, Timothy S Brown, Nicholas A Bedard\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Length of stay (LOS) following total knee arthroplasty (TKA) has decreased over recently years. In 2018, the Centers for Medicare and Medicaid Services removed TKA from Inpatient-Only List (IPO), incentivizing further expansion of outpatient TKA. However, many patients may still require postsurgical hospitalization. The purpose of this study was to assess early outcomes for TKA based on length of stay (LOS).</p><p><strong>Methods: </strong>We identified patients undergoing elective, primary TKA in the National Surgical Quality Improvement Program database using CPT code 27447 between 2015 and 2018. Patients were stratified by length of stay (LOS) 0 days, 1-2 days, and ≥3 days. Thirty-day rates of any complication, wound complications, readmission, and reoperation were assessed. Multivariate analysis was performed to adjust for confounding variables.</p><p><strong>Results: </strong>5,655 (3%) patients underwent outpatient TKA, 130,543 (59%) had LOS 1-2 days, and 84,986 (38%) had LOS ≥3 days. Any complication was experienced in 4.1% of those with LOS 0 days, 4.3% for those with LOS of 1-2 days, and 10.5% for patients with LOS ≥3 days (p<0.0001). Readmission occurred in 2.2%, 2.6%, and 4.0% for the 3 groups, respectively (p<0.0001). After multivariate analysis, there was no significant difference in any outcome measure between patients with LOS 0 and 1-2 days, however those with LOS ≥3 days had higher odds of complications, reoperation, and readmission.</p><p><strong>Conclusion: </strong>A significant number of patients had LOS ≥3 days following TKA and had more comorbidities and complications. Outpatient TKA was not associated with increased early complication compared to those with LOS of 1-2 days. Despite expansion of outpatient surgery, postsurgical hospitalization remains an integral part of care following TKA. <b>Level of Evidence: III</b>.</p>\",\"PeriodicalId\":35582,\"journal\":{\"name\":\"The Iowa orthopaedic journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769343/pdf/IOJ-2022-053.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Iowa orthopaedic journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Iowa orthopaedic journal","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Longer Length of Stay Is Associated With More Early Complications After Total Knee Arthroplasty.
Background: Length of stay (LOS) following total knee arthroplasty (TKA) has decreased over recently years. In 2018, the Centers for Medicare and Medicaid Services removed TKA from Inpatient-Only List (IPO), incentivizing further expansion of outpatient TKA. However, many patients may still require postsurgical hospitalization. The purpose of this study was to assess early outcomes for TKA based on length of stay (LOS).
Methods: We identified patients undergoing elective, primary TKA in the National Surgical Quality Improvement Program database using CPT code 27447 between 2015 and 2018. Patients were stratified by length of stay (LOS) 0 days, 1-2 days, and ≥3 days. Thirty-day rates of any complication, wound complications, readmission, and reoperation were assessed. Multivariate analysis was performed to adjust for confounding variables.
Results: 5,655 (3%) patients underwent outpatient TKA, 130,543 (59%) had LOS 1-2 days, and 84,986 (38%) had LOS ≥3 days. Any complication was experienced in 4.1% of those with LOS 0 days, 4.3% for those with LOS of 1-2 days, and 10.5% for patients with LOS ≥3 days (p<0.0001). Readmission occurred in 2.2%, 2.6%, and 4.0% for the 3 groups, respectively (p<0.0001). After multivariate analysis, there was no significant difference in any outcome measure between patients with LOS 0 and 1-2 days, however those with LOS ≥3 days had higher odds of complications, reoperation, and readmission.
Conclusion: A significant number of patients had LOS ≥3 days following TKA and had more comorbidities and complications. Outpatient TKA was not associated with increased early complication compared to those with LOS of 1-2 days. Despite expansion of outpatient surgery, postsurgical hospitalization remains an integral part of care following TKA. Level of Evidence: III.
期刊介绍:
Any original article relevant to orthopaedic surgery, orthopaedic science or the teaching of either will be considered for publication in The Iowa Orthopaedic Journal. Articles will be enthusiastically received from alumni, visitors to the department, members of the Iowa Orthopaedic Society, residents, and friends of The University of Iowa Department of Orthopaedics and Rehabilitation. The journal is published every June.