新冠疫情期间，同一天出院的髋关节和膝关节置换术是否会增加早期并发症？
Did Rapid Expansion of Same Day Discharge Hip and Knee Arthroplasty During the COVID-19 Pandemic Increase Early Complications?
机构信息
Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
出版信息
Iowa Orthop J. 2023 Dec;43(2):31-37.
BACKGROUND
The COVID-19 pandemic has had a lasting impact on patients seeking total hip and knee arthroplasty (THA, TKA) including more patients undergoing same day discharge (SDD) following total joint arthroplasty (TJA). The purpose of this study was to assess whether expansion of SDD TJA during the COVID-19 pandemic resulted in more early complications following TJA. We anticipated that as many institutions quickly launched SDD TJA programs there may be an increase in 30-day complications.
METHODS
We retrospectively queried the ACS-NSQIP database for all patients undergoing primary elective TJA from January 1, 2018, to December 31, 2020. Participants who underwent THA or TKA between January 1, 2018 and March 1, 2020 were grouped into pre-COVID and between March 1, 2020 and December 31, 2020 were grouped into post-COVID categories. Patients with length of stay greater than 0 were excluded. Primary outcome was any complication at 30 days. Secondary outcomes included readmission and re-operation 30 days.
RESULTS
A total of 14,438 patients underwent TKA, with 9,580 occurring pre-COVID and 4,858 post-COVID. There was no difference in rates of total complication between the pre-COVID (3.55%) and post-COVID (3.99%) groups (p=0.197). Rates of readmissions for were similar for the pre-COVID (1.75%) and post-COVID (1.98%) groups (p=0.381). There was no statistically significant difference in respiratory complications between the pre-COVID (0.41%) and post-COVID group (0.23%, p=0.03). A total of 12,265 patients underwent THA, with 7,680 occurring pre-COVID and 4,585 post-COVID. There was no difference in rates of total complication between the pre-COVID (3.25%) and post-COVID (3.49%) groups (p=0.52). Rates of readmissions for were similar for the pre-COVID (1.77%) and post-COVID (1.68%) groups (p=0.381). There was no statistically significant difference in respiratory complications between the pre-COVID (0.16%) and post-COVID group (0.07%, p=0.26). Combined data to include THA and TKA patients did not find a statistical difference in the rate of complications or readmission but did note a decrease in the rate of combined respiratory complications in the post-COVID group (0.15% vs. 0.30%, p=0.028).
CONCLUSION
Rapid expansion of SDD TJA during the COVID-19 pandemic did not increase overall complication, readmission, or re-operation rates. .
背景
新冠疫情对寻求全髋关节和全膝关节置换术（THA、TKA）的患者产生了持久影响，包括更多患者在接受全关节置换术后当天出院（SDD）。本研究旨在评估新冠疫情期间 SDD TJA 的扩展是否导致 TJA 后早期并发症增加。我们预计，许多机构会迅速推出 SDD TJA 计划，因此 30 天并发症可能会增加。
方法
我们回顾性地查询了 ACS-NSQIP 数据库中所有 2018 年 1 月 1 日至 2020 年 12 月 31 日期间接受初次择期 TJA 的患者数据。2018 年 1 月 1 日至 3 月 1 日期间接受 THA 或 TKA 的患者分为新冠前组，2020 年 3 月 1 日至 12 月 31 日期间接受的患者分为新冠后组。排除住院时间大于 0 的患者。主要结局是 30 天内任何并发症。次要结局包括 30 天内再入院和再手术。
结果
共有 14438 例患者接受 TKA，其中 9580 例发生在新冠前，4858 例发生在新冠后。新冠前组（3.55%）和新冠后组（3.99%）的总并发症发生率无差异（p=0.197）。新冠前组（1.75%）和新冠后组（1.98%）的再入院率相似（p=0.381）。新冠前组（0.41%）和新冠后组（0.23%，p=0.03）的呼吸并发症无统计学差异。共有 12265 例患者接受 THA，其中 7680 例发生在新冠前，4585 例发生在新冠后。新冠前组（3.25%）和新冠后组（3.49%）的总并发症发生率无差异（p=0.52）。新冠前组（1.77%）和新冠后组（1.68%）的再入院率相似（p=0.381）。新冠前组（0.16%）和新冠后组（0.07%，p=0.26）的呼吸并发症无统计学差异。包括 THA 和 TKA 患者的数据并未发现并发症或再入院率的统计学差异，但注意到新冠后组的呼吸并发症总发生率有所下降（0.15%比 0.30%，p=0.028）。
结论
新冠疫情期间 SDD TJA 的快速扩展并未增加总体并发症、再入院或再手术率。
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