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Xia K, Min L, Xie W, Yang G, Yon DK, Lee SW, Koyanagi A, Jacob L, Smith L, Shin JI, Rahmati M, Xiao W, Li Y. Is unicompartmental knee arthroplasty a better choice than total knee arthroplasty for unicompartmental osteoarthritis? A systematic review and meta-analysis of randomized controlled trials. Chin Med J (Engl) 2024:00029330-990000000-01143. [PMID: 38997246 DOI: 10.1097/cm9.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The choice of unicompartmental knee arthroplasty (UKA) vs. total knee arthroplasty (TKA) in the surgical treatment of knee osteoarthritis (KOA) remains controversial. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the clinical results of UKA and TKA for treating unicompartmental KOA. METHODS PubMed, Embase, and the Cochrane Library were systematically searched for articles published up to January 2, 2023. The literature was rigorously screened to include only RCTs comparing UKA and TKA for unicompartmental KOA. A systematic review and meta-analysis were performed to calculate the mean difference (MD), relative risk (RR), and 95% confidence interval (CI) according to the Cochrane standards. RESULTS Thirteen publications involving 683 UKAs and 683 TKAs were analyzed. Except for one study with a follow-up period of 15 years, all outcome measures reported were within 5 years of follow-up. Meta-analysis showed better knee recovery (MD: 1.23; 95% CI: 1.01-1.45; P <0.00001), greater knee function (MD: 1.78; 95% CI: 0.34-3.22; P = 0.02), less pain (MD: 0.75; 95% CI: 0.43-1.06; P <0.00001), and better health status (MD: 3.75; 95% CI: 0.81-6.69; P = 0.01) after UKA than TKA. However, considering the minimal clinically important difference values for these variables, the findings were not clinically relevant. Moreover, UKA patients had fewer complications (RR: 0.59; 95% CI: 0.45-0.78; P = 0.0002) and shorter hospital stays (MD: -0.89; 95% CI: -1.57 to -0.22; P = 0.009) than did TKA patients. There were no statistically significant differences in terms of postoperative range of movement, revision, failure, operation time, and patient satisfaction. CONCLUSIONS In terms of clinical efficacy, there was no obvious advantage of UKA over TKA in the surgical treatment of knee OA when considering the minimal clinically important difference. The main advantage of UKA over TKA is that it leads to fewer complications and a shorter length of hospital stay. It is ideal to perform prospective studies with longer follow-up periods to fully evaluate the long-term efficacy and safety of the two procedures in the future.
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Affiliation(s)
- Kuanyu Xia
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Lang Min
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Wenqing Xie
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410083, China
| | - Guang Yang
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410083, China
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University College of Medicine, Suwon, Republic of Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 08830 Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 08830 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 28029 Madrid, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, France
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khorramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Wenfeng Xiao
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410083, China
| | - Yusheng Li
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410083, China
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Fan Y, Xu Q, Jin G, Jiang L, Wang C. The cost of total hip arthroplasty: compare the hospitalization costs of national centralized procurement and national volume-based procurement. Front Public Health 2024; 12:1383308. [PMID: 39040867 PMCID: PMC11260701 DOI: 10.3389/fpubh.2024.1383308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Background With the increasing demand for joint replacement surgery in China, the government has successively issued the policies of national centralized procurement (NCP) and national volume-based procurement (NVBP) of artificial joints. The purpose of this study is to evaluate the impact of NCP and NVBP policies on hospitalization cost, rehospitalization and reoperation rate of total hip arthroplasty (THA). Methods In total, 347 patients who underwent THA from January 2019 to September 2022 were retrospectively analyzed. According to the implementation of NCP and NVBP, patients were divided into three groups: control group (n = 147), NCP group (n = 130), and NVBP group (n = 70). Patient-level data on the total hospitalization costs, rehospitalization rate, THA reoperation rate and inpatient component costs were collected before and after the implementation of the policies and Consumer Price Index was used to standardize the cost. Results After the implementation of NCP and NVBP, the total cost of hospitalization decreased by $817.41 and $3950.60 (p < 0.01), respectively. The implantation costs decreased from $5264.29 to $4185.53 and then rapidly to $1143.49 (p < 0.01), contributing to increased total cost savings. However, the cost of surgery and rehabilitation increased after NCP and NVBP implementation (p < 0.01). The proportion of implants decreased from 66.76 to 59.22% and then to 29.07%, whereas that of drugs increased from 7.98 to 10.11% and then to 12.06%. The proportion of operating expenses rose from 4.86 to 8.01% and then to 18.47%. Univariate linear regression analysis showed that hospital stay, NCP and NVBP were correlated with total hospitalization cost (p < 0.01). Multivariate analysis showed that hospital stay, NCP and NVBP were independent predictors of total hospitalization cost (p < 0.01). Conclusion In this study, hospital stay, NCP, and NVBP were independent predictors of total inpatient costs. After the implementation of NVBP policy, the cost of implants and hospitalization has decreased significantly, and the technical labor value of medical staff has increased, but a multifaceted method is still needed to solve the problem of increasing costs of other consumables. Limitations of the study suggest the need for further and more comprehensive evaluation in the future.
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Zhang X, Tang S, Wang R, Qian M, Ying X, Maciejewski ML. Hospital response to a new case-based payment system in China: the patient selection effect. Health Policy Plan 2024; 39:519-527. [PMID: 38581671 PMCID: PMC11095269 DOI: 10.1093/heapol/czae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024] Open
Abstract
Providers have intended and unintended responses to payment reforms, such as China's new case-based payment system, i.e. Diagnosis-Intervention Packet (DIP) under global budget, that classified patients based on the combination of principal diagnosis and procedures. Our study explores the impact of DIP payment reform on hospital selection of patients undergoing total hip/knee arthroplasty (THA/TKA) or with arteriosclerotic heart disease (AHD) from July 2017 to June 2021 in a large city. We used a difference-in-differences approach to compare the changes in patient age, severity reflected by the Charlson Comorbidity Index (CCI), and a measure of treatment intensity [relative weight (RW)] in hospitals that were and were not subject to DIP incentives before and after the DIP payment reform in July 2019. Compared with non-DIP pilot hospitals, trends in patient age after the DIP reform were similar for DIP and non-DIP hospitals for both conditions, while differences in patient severity grew because severity in DIP hospitals increased more for THA/TKA (P = 0.036) or dropped in non-DIP hospitals for AHD (P = 0.011) following DIP reform. Treatment intensity (measured via RWs) for AHD patients in DIP hospitals increased 5.5% (P = 0.015) more than in non-DIP hospitals after payment reform, but treatment intensity trends were similar for THA/TKA patients in DIP and non-DIP hospitals. When the DIP payment reform in China was introduced just prior to the pandemic, hospitals subject to this reform responded by admitting sicker patients and providing more treatment intensity to their AHD patients. Policymakers need to balance between cost containment and the unintended consequences of prospective payment systems, and the DIP payment could also be a new alternative payment system for other countries.
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Affiliation(s)
- Xinyu Zhang
- School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200030, China
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, United States
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, United States
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu 215316, China
- SingHealth Duke-NUS Global Health Institute, Duke-NUS, 8 College Road, Singapore 169857, Singapore
| | - Ruixin Wang
- School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200030, China
| | - Mengcen Qian
- School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200030, China
- Key Laboratory of Health Technology Assessment, National Health Commission (Fudan University), 130 Dong’an Road, Shanghai 200030, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, 130 Dong’an Road, Shanghai 200030, China
- Key Laboratory of Health Technology Assessment, National Health Commission (Fudan University), 130 Dong’an Road, Shanghai 200030, China
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705, United States
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC 27701, United States
- Division of General Internal Medicine, Department of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC 27710, United States
- Duke-Margolis Health Policy Center, Duke University, 230 Science Drive, Durham, NC 27708, United States
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Chen S, Qiang M, Li K, Wang X, Wang W, Xie J. Identifying patients at risk of prolonged hospital length of stay after total knee arthroplasty: A real-world study on the creation and validation of a cloud estimator. BIOMOLECULES & BIOMEDICINE 2024; 24:144-152. [PMID: 37540587 PMCID: PMC10787627 DOI: 10.17305/bb.2023.9156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
Accurate prediction of the length of stay for patients undergoing total knee arthroplasty (TKA) is critical for efficient medical resource allocation. This study aimed to create a user-friendly model to assist this estimation process. A secondary analysis was conducted on 2676 patients who underwent elective primary TKA at a tertiary academic medical center in Singapore from January 2013 to June 2014. The eligible patients (n = 2600) were randomly divided into a training cohort (n = 2081) and a validation cohort (n = 519), at a ratio of 4:1. A prolonged hospital stay was defined as exceeding six days. Multivariable logistic regression was used to develop a prediction model, and an online calculator was created to facilitate its application. The model's discrimination power, goodness-of-fit, and clinical applicability were evaluated. Additionally, models using other statistical methods were developed for performance comparison. The model includes predictors such as age, operation duration, history of cerebrovascular accidents, creatinine levels, procedure site, the American Society of Anesthesiologists Physical status, hemoglobin levels, and primary anesthesia type. The model demonstrated robust discrimination power with a C statistic of 0.70 (95% confidence interval, 0.64 to 0.75), satisfactory goodness-of-fit (Hosmer-Lemeshow test, P=0.286), and was applicable when thresholds were between 0.08 and 0.52, based on decision curve analysis. A predictive model was developed that can be used to identify patients who are likely to require an extended stay following TKA. This could assist in planning bed availability and guiding therapeutic decisions.
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Affiliation(s)
- Song Chen
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China
| | - Minfei Qiang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kunpeng Li
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiong Wang
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai, China
| | - Wei Wang
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China
| | - Jun Xie
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China
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