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独立的门诊外科中心和接受门诊膝关节关节整形手术的患者

Charlotte M Rajasingh¹, Laurence C Baker², Sherry M Wren¹

¹Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.

JAMA network open

|August 10, 2023

概括

在医疗保险2018年政策变化之后,门诊膝关节关节整形手术的使用量增加了. 独立的门诊外科中心 (FASCs) 越来越多地治疗健康患者,而医院拥有的外科中心 (HOSCs) 则照顾更脆弱的人群.

科学领域:

整形外科手术整形外科手术
医疗保健服务研究医疗服务研究
卫生政策卫生政策

背景情况:

医疗保险在2018年将全膝关节整形术 (TKA) 从仅限住院治疗的手术中删除,扩大了门诊TKA的资格.
换班创造了门诊膝关节关节整形手术的新患者池,需要了解患者的特征.
目前尚不清楚这一政策变化如何影响医院拥有的手术中心 (HOSCs) 与独立的门诊手术中心 (FASCs) 的患者人口统计.

研究的目的:

描述2017年和2018年接受门诊,选择性全膝关节和部分膝关节整形手术的患者.
在此期间,将在FASC和HOSC接受治疗的患者队列进行比较.

主要方法:

一项观察性,回顾性队列研究利用了2017年和2018年佛罗里达州和威斯康星州门诊手术数据库的数据.
总共有5657名接受选择性门诊部分和全膝关节整形手术的患者被纳入.
使用国家住院患者数据库识别了以前的入院病例;从2022年3月到6月进行了统计分析.

主要成果:

门诊膝关节关节置换术从2017年的1910年显著增加到2018年的3747次,膝关节关节置换术总数显著增加.
在FASC中,私人付款人保险患者和白人患者的增加更大,以及来自社会脆弱性较低社区的患者的增加更大.
与HOSC (2018年8.1%) 相比,FASCs的先前入院患者比例下降了 (2018年4.0%),这表明FASCs转向更健康的患者.

结论:

2018年政策变化后门诊膝关节整形术的增加与FASCs治疗更高比例的健康,私人保险的白人患者有关.
随后,HOSC照顾的更大比例是患有更严重疾病的更易受伤害的患者.
这表明,在获得FASCs方面的变化可能会增加,这可能会加剧对复杂患者的护理差异.

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