人工全关节置换术后非计划再次入院的原因、危险因素及预防分析

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摘要目的分析初次行人工全关节置换术(total joint arthroplasty，TJA)患者出院后90 d内非计划再次入院的原因、危险因素以及可预防性。方法回顾性收集2016年6月至2018年6月在本院初次行TJA的患者348例，分为90 d内非计划再入院组和非再入院组，统计样本的术前、临床及出院后资料，用 t 检验比较两组样本的资料情况是否有统计学意义，再用多变量logistic回归分析再入院组的相关危险因素，最后由专家组分析、判断再入院组的可预防情况。结果初次行TJA患者出院后90 d内非计划再入院率为5.7%，主要原因为僵硬、脱位、伤口感染等，其中8例是可预防的。两组患者资料显示：身体质量指数(body mass index，BMI)、察尔森共病指数(charlson comorbidity index，CCI)、支付方式、学历水平比较差异有统计学意义。多变量 Logistic回归分析结果表明，患者BMI、CCI是出院后 90 d内非计划再入院的危险因素。结论对患者进行严格术前筛选、评估，优化患者术中、术后的治疗措施，正确的引导患者术后康复训练，才能更好识别危险因素、减少并发症，进而降低非计划再入院率。

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	杜昆伦
	白希壮 *

关键词 ：非计划再入院, 全关节置换术, 危险因素, 并发症

Abstract：Objective To analyze the causes，risk factors and prophylaxis of unplanned readmission in patients with total joint arthroplasty within 90 days of discharge.Methods A retrospective analysis of 348 patients with ostarthritis undergoing TJA were performed in June 2016 to June 2018 in our hospital.These patients were assigned into readmission group and non-readmission group according to whether or not they had been readmitted within 90 days after discharge.By comparing the clinical data of two groups，related risk factors of readmission group were analyzed by multivariate logistic regression models and student's test.Finally，the panel assessed whether patients in the unplanned readmission group could be prevented.Results The unplanned readmission rate of TJA within 90 days after discharge was 5.7 percent.The main reasons were stiffness，dislocation，wound infection，etc.There were 8 preventable cases.The differences of BMI，CCI，pattern of payment and education levels between the two groups were statistically significant.The results of multivariate Logistic regression analysis indicated that BMI，CCI were risk factors for unplanned readmission within 90 days after discharge.Conclusion The patients should be screened and evaluated strictly before surgery，the treatment measures during and after surgery should be optimized，and the postoperative rehabilitation training should be guided correctly to better identify risk factors，reduce complications，and further reduce the rate of unplanned readmission.

Key words： unplanned readmission total joint arthroplasty risk factors complications

基金资助:辽宁省自然科学基金(2017107007)

通讯作者: 白希壮

作者简介: 杜昆伦(1990－ )，男，医师，中国医科大学人民医院骨科，110000。

引用本文:

杜昆伦，白希壮 *. 人工全关节置换术后非计划再次入院的原因、危险因素及预防分析[J]. 实用骨科杂志, 2019, 25(8): 681-685.
Du Kunlun，Bai Xizhuang *. Causes，Risk Factors and Preventive Analysis of Unplanned Readmission After Total Joint Arthroplasty. sygkzz, 2019, 25(8): 681-685.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I8/681

［1］Parvizi J，Mui A，Purtill JJ，et al.Total joint arthroplasty：When do fatal or near-fatal complications occur?［J］.J Bone Joint Surg(Am)，2007，89(1)：27-32.
［2］Landrum L，Weinrich S.Readmission data for outcomes measurement：identifying and strengthening the empirical base［J］.Qual Manag in Health Care，2006，15(2)：83-95.
［3］Halfon P，Eggli Y，Prêtre-Rohrbach I，et al.Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care［J］.Medical Care，2006，44(11)：972-981.
［4］Cram P，Lu X，Kaboli PJ，et al.Clinical characteristics and outcomes of medicare patients undergoing total hip arthroplasty，1991-2008［J］.JAMA，2011，305(15)：1560-1567.
［5］Vorhies JS，Wang Y，Herndon JH，et al.Decreased length of stay after TKA Is not associated with increased readmission rates in a national medicare sample［J］.Clin Orthop Relat Res，2012，470(1)：166-171.
［6］Bozic KJ，Maselli J，Pekow PS，et al.The influence of procedure volumes and standardization of care on quality and efficiency in total joint replacement surgery［J］.J Bone Joint Surg(Am)，2010，92(16)：2643-2652.
［7］Lee SW，Kumar GK，Kim TK.Unplanned readmissions after primary total knee arthroplasty in Korean patients：Rate，causes，and risk factors［J］.Knee，2017，24(3)：670-674.
［8］Zmistowski B，Restrepo C，Hess J，et al.Unplanned readmission after total joint arthroplasty：Rates，reasons，and risk factors［J］.J Bone Joint Surg(Am)，2013，95(20)：1869-1876.
［9］Saucedo JM，Marecek GS，Wanke TR，et al.Understanding readmission after primary total hip and knee arthroplasty：Who’s at risk?［J］.J Arthroplasty，2014，29(2)：256-260.
［10］Schairer WW，Vail TP，Bozic KJ.What are the rates and causes of hospital readmission after total knee arthroplasty?［J］.Clin Orthop Relat Res，2014，472(1)：181-187.
［11］Issa K，Cherian JJ，Kapadia BH，et al.Readmission rates for cruciate-retaining total knee arthroplasty［J］.J Knee Surg，2015，28(3)：239-242.
［12］Kurtz SM，Lau EC，Ong KL，et al.Which hospital and clinical factors drive 30 and 90 days readmission after TKA?［J］.J Arthroplasty，2016，31(10)：2099-2107.
［13］Bini SA，Fithian DC，Paxton LW，et al.Does discharge disposition after primary total joint arthroplasty affect readmission rates?［J］.J Arthroplasty，2010，25(1)：114-117.
［14］Cullen C，Johnson DS，Cook G.Re-admission rates within 28 days of total hip replacement［J］.Ann R Coll Surg Engl，2006，88(5)：475.
［15］Vorhies JS，Wang Y，Herndon J，et al.Readmission and length of stay after total hip arthroplasty in a national Medicare sample［J］.J Arthroplasty，2011，26(6)：119-123.
［16］Adelani MA，Keeney JA，Nunley RM，et al.Readmission following total knee arthroplasty：venous thromboembolism as a "never event" is a counterproductive misnomer［J］.J Arthroplasty，2013，28(5)：747-750.
［17］Lavernia CJ，Villa JM，Iacobelli DA.Readmission rates in the state of Florida：a reflection of quality?［J］.Clin Orthop Relat Res，2013，471(12)：3856-3862.
［18］Mesko NW，Bachmann KR，Kovacevic D，et al.Thirty-day readmission following total hip and knee arthroplasty-a preliminary single institution predictive model［J］.J Arthroplasty，2014，29(8)：1532-1538.
［19］Voskuijl T，Hageman M，Ring D.Higher charlson comorbidity index scores are associated with readmission after orthopaedic surgery［J］.Clin Orthop Relat Res，2014，472(5)：1638.
［20］Schaeffer JF，Scott DJ，Godin JA，et al.The association of ASA class on total knee and total hip arthroplasty readmission rates in an academic hospital［J］.J Arthroplasty，2015，30(5)：723-727.
［21］Varacallo MA，Herzog L，Toossi N，et al.Ten-year trends and independent risk factors for unplanned readmission following elective total joint arthroplasty at a large urban academic hospital［J］.J Arthroplasty，2017，32(6)：1739-1746.
［22］Dowsey MM，Liew D，Choong PF.Economic burden of obesity in primary total knee arthroplasty［J］.Arthritis Care Res(Hoboken)，2011，63(10)：1375-1381.
［23］Hanly RJ，Marvi SK，Whitehouse SL，et al.Morbid obesity in total hip arthroplasty：redefining outcomes for operative time，length of stay，and readmission［J］.J Arthroplasty，2016，31(9)：1949-1953.
［24］Schwarzkopf R，Thompson SL，Adwar SJ，et al.Postoperative complication rates in the “Super-Obese” hip and knee arthroplasty population［J］.J Arthroplasty，2012，27(3)：397-401.
［25］朱元莉，蔡聪，肖骏，等.肥胖患者膝关节置换的挑战与近期疗效分析［J］.实用骨科杂志，2017(10)：28-30；51.
［26］Weinberg DS，Kraay MJ，Fitzgerald SJ，et al.Are readmissions after THA preventable?［J］.Clin Orthop Relat Res，2017，475(5)：1414-1423.
［27］Jørgensen CC，Petersen MA，Kehlet H.Preoperative prediction of potentially preventable morbidity after fasttrack hip and knee arthroplasty：a detailed descriptive cohort study［J］.BMJ Open，2016，6(1)：e009813.
［28］Benbassat J，Taragin M.Hospital readmissions as a measure of quality of health care：advantages and limitations［J］.Arch Intern Med，2000，160(8)：1074-1081.
［29］Keeney JA，Adelani MA，Nunley RM，et al.Assessing readmission databases：how reliable is the information?［J］.J Arthroplasty，2012，27(8)：7276；e1-e2.
［30］Saucedo J，Marecek GS，Lee J，et al.How accurately are we coding readmission diagnoses after total joint arthroplasty?［J］.J Arthroplasty，2013，28(7)：1076-1079.