目的:本研究旨在评估病例组合的时间趋势,并评估主要THA后的修订风险和原因,TKA,和UKA在荷兰的私立和公立医院。
方法:我们回顾性分析了2014年至2023年期间植入的476,312例原发性关节置换术(公共:n=413,560,私人n=62,752)。我们调查了病人的人口统计学,程序详细信息,随着时间的推移,并按医院类型进行修订。对可比亚组计算了调整后的修订风险(ASAI/II,年龄≤75,BMI≤30,骨关节炎诊断,和中高社会经济地位(SES)。
结果:私立医院的THA和TKA数量从2014年的4%和9%增加到2022年的18%和21%。私立医院的病人更年轻,ASA分类较低,较低的BMI,与公立医院患者相比,SES更高。在私立医院,年龄和ASAII比例随时间增加。多变量Cox回归显示主要THA的修订风险较低(HR0.7,CI0.7-0.8),TKA(HR0.8,CI0.7-0.9),和私立医院的UKA(HR0.8,CI0.7-0.9)。在私立医院进行初次关节成形术后,49%的THA和37%的TKA修订在公立医院进行。
结论:私立医院的患者年龄较小,ASA分类较低,较低的BMI,与公立医院患者相比,SES较高。私家医院的关节置换术人数增加,与公立医院相比,修订风险较低。
OBJECTIVE: This study aims to assess time trends in
case-mix and to evaluate the risk of revision and causes following primary THA, TKA, and UKA in private and public hospitals in the Netherlands.
METHODS: We retrospectively analyzed 476,312 primary arthroplasties (public: n = 413,560 and private n = 62,752) implanted between 2014 and 2023 using Dutch Arthroplasty Register data. We explored patient demographics, procedure details, trends over time, and revisions per hospital type. Adjusted revision risk was calculated for comparable subgroups (ASA I/II, age ≤ 75, BMI ≤ 30, osteoarthritis diagnosis, and moderate-high socioeconomic status (SES).
RESULTS: The volume of THAs and TKAs in private hospitals increased from 4% and 9% in 2014, to 18% and 21% in 2022. Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES compared with public hospital patients. In private hospitals, age and ASA II proportion increased over time. Multivariable Cox regression demonstrated a lower revision risk for primary THA (HR 0.7, CI 0.7-0.8), TKA (HR 0.8, CI 0.7-0.9), and UKA (HR 0.8, CI 0.7-0.9) in private hospitals. After initial arthroplasty in private hospitals, 49% of THA and 37% of TKA revisions were performed in public hospitals.
CONCLUSIONS: Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES com-pared with public hospital patients. The number of arthroplasties increased in private hospitals, with a lower revision risk compared with public hospitals.