Length of stay and inpatient charges of total knee arthroplasty in China: analysis of a national database / 中华医学杂志(英文版)

BACKGROUND@#There are limited data on the resource utilization of total knee arthroplasty (TKA) in China. This study aimed to examine the length of stay (LOS) and inpatient charges of TKA in China, and to investigate their determinants.@*METHODS@#We included patients undergoing primary TKA in the Hospital Quality Monitoring System in China between 2013 and 2019. LOS and inpatient charges were obtained, and their associated factors were further assessed using multivariable linear regression.@*RESULTS@#A total of 184,363 TKAs were included. The LOS decreased from 10.8 days in 2013 to 9.3 days in 2019. The admission-to-surgery interval decreased from 4.6 to 4.2 days. The mean inpatient charges were 61,208.3 Chinese Yuan. Inpatient charges reached a peak in 2016, after which a gradual decrease was observed. Implant and material charges accounted for a dominating percentage, but they exhibited a downward trend, whereas labor-related charges gradually increased. Single marital status, non-osteoarthritis indication, and comorbidity were associated with longer LOS and higher inpatient charges. Female sex and younger age were associated with higher inpatient charges. There were apparent varieties of LOS and inpatient charges among provincial or non-provincial hospitals, hospitals with various TKA volume, or in different geographic regions.@*CONCLUSIONS@#The LOS following TKA in China appeared to be long, but it was shortened during the time period of 2013 to 2019. The inpatient charges dominated by implant and material charges exhibited a downward trend. However, there were apparent sociodemographic and hospital-related discrepancies of resource utilization. The observed statistics can lead to more efficient resource utilization of TKA in China.

In-hospital mortality and related risk factors after knee replacement in China: based on national hospital quality monitoring system data / 中华骨科杂志

Objective:To estimate in-hospital mortality after knee replacement (KR) and to assess its trend and risk factors in China.Methods:We included patients undergoing KR in the Hospital Quality Monitoring System in China (2013-2019) to estimate in-hospital mortality after KR and assessed relation of patient's and hospital's characteristics (year of surgery, age, gender, marital status, primary indication, Charlson comorbidity index, geographic location, hospital type, hospital volume of KR, and surgery type) to in-hospital mortality using multivariable Poisson regression.Results:The annual amount of KR has increased from 20 307 in 2013 to 35 757 in 2019, and has maintained an upward trend for 7 years. The mean age of patients having KR increased from 64.9 years in 2013 to 66.6 years in 2019. Of the total 218 923 KRs, 63 deaths (0.29‰) occurred within 30 days before discharging. Older age was associated with higher in-hospital mortality ( P for trend <0.001). Male gender had higher incidence of in-hospital mortality compared with female [relative risk (RR), 2.5; 95% CI: 1.5, 4.1]. Single marital status was associated with higher, albeit non-statistically significant, in-hospital mortality than married patients (RR, 2.1; 95% CI: 0.9, 4.6). Higher Charlson comorbidity index was associated with increased risk of in-hospital mortality ( P for trend <0.001). Risk of in-hospital mortality decreased with more hospital-year knee replacement surgeries ( P for trend <0.001). In-hospital mortality varied by geographic regions, with the lowest mortality in East region (0.16‰), followed by South-West (0.31‰), South-Central (0.31‰), North region (0.33‰), North-West (0.54‰) and North-East (0.59‰). Conclusion:In-hospital mortality after KR in China was relatively low. Older age, male gender, higher Charlson comorbidity index and lower hospital-year knee replacement surgeries were risk factors for in-hospital mortality. The mortality varied greatly according to the geographic location of hospital.

Association between red blood cell volume distribution width and osteophytes: A cross-sectional study / 中南大学学报(医学版)

To investigate the association between red blood cell volume distribution width (RDW) and osteophytes.
 Methods: This cross-sectional study was conducted in the Department of Health Examination Center of Xiangya Hospital, Central South University in Changsha, Hunan Province, China. A total of 8 334 subjects were included in this study. The severity of osteophytes was graded using the criteria of the Osteoarthritis Research Society International (OARSI). Osteophytes incident was defined as at least one side of the knee had a osteophytes grade ≥1. According to the quartiles of the RDW level, the subjects were divided into 4 groups. Multivariate logistic regression analysis was used to calculate the odds ratio (OR) and the 95% confidence interval (CI) of the knee osteophytes incidence between each RDW group and the lowest level group. Tests for linear trends were conducted based on logistic regression using a median variable of RDW level in each category.
 Results: Quartile 1 (Q1), RDW≤9.78; Q2, 9.7813.10. The multivariable adjusted ORs (95%CI) of the prevalence of osteophytes were 1.38 (1.06 to 1.79) in the second percentile interval, and 1.27 (0.97 to 1.66) and 1.50 (1.15 to 1.94) in the third and fourth percentile interval, respectively. Test for linear trends suggested that there was a positive association between the RDW level and the risk of knee osteophytes incidence (P=0.019).
 Conclusion: The risk of osteophytes incidence increases with the increasing RDW levels.

Autograft versus non-irradiated allograft for anterior cruciate ligament reconstruction:a meta-analysis / 中国组织工程研究

BACKGROUND:Reconstruction of the anterior cruciate ligament has become the gold-standard treatment for an anterior cruciate ligament rupture. Despite the popularity of the procedure, there remains a considerable amount of controversies over whether an autograft or anal ograft should be used for primary anterior cruciate ligament reconstruction. OBJECTIVE:To compare the clinical outcomes of al ograft and autograft in primary anterior cruciate ligament reconstruction. METHODS:Randomized control ed trials concerning autograft versus non-irradiated al ograft for anterior cruciate ligament reconstruction were identified from the PubMed/Medline database conducted up to July 12, 2014. These studies were selected independently by two reviewers according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman5.2 software. RESULTS AND CONCLUSION:A total of 6 randomized control ed trials consisting of 858 cases were included, 441 cases in autograft group and 417 cases in non-irradiated al ograft. The results of the meta-analysis indicate no significant difference between autografts and non-irradiated al ografts in overal IKDC [relative risk (RR)=1.02, 95%confidence interval (CI) (0.99 to 1.06), P=0.21], degree of laxity [mean difference (MD)=-0.13, 95%CI (-0.29 to-0.02), P=0.09], Lachman test [RR=1.04, 95%CI (0.95 to 1.13), P=0.37], pivot shift test [RR=1.00, 95%CI (0.95 to 1.05), P=0.96], one-leg hop test [RR=1.01, 95%CI (0.96 to 1.06), P=0.77], Lysholm score [MD=-0.64, 95%CI (-1.45 to 0.17), P=0.12], Tegner score [MD=0.16, 95%CI (-0.16 to 0.47), P=0.34] and rate of postoperative complications [RR=1.42, 95%CI (0.67 to 3.04), P=0.36]. Therefore, in the meta-analysis, there is no significant difference between autograft and non-irradiated al ograft in clinical outcomes. However due to the limitations of our study, further work is needed to determine this conclusion.

Efficacy of neuromuscular electrical stimulation on pain of patients with knee osteoarthritis:a meta-analysis / 中国组织工程研究

BACKGROUND:Symptomatic treatment is the main management strategy for patients with knee osteoarthritis at early metaphase. Some previous studies have demonstrated that neuromuscular electrical stimulation can al eviate pain in knee osteoarthritis patients. To date, this effectiveness, however, stil remains controversial. OBJECTIVE:To assess the efficacy of neuromuscular electrical stimulation on pain in patients with knee osteoarthritis. METHODRandomized control ed trials concerning the efficacy of neuromuscular electrical stimulation in the treatment of knee osteoarthritis were identified from the Medline database conducted up to July 3, 2014. These studies were selected independently by two reviewers according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman5.2 software. RESULTS AND CONCLUSION:A total of 5 randomized control ed trials consisting of 239 participants were included. The results of the meta-analysis indicate neuromuscular electrical stimulation has no significant impact on measure of pain in knee osteoarthritis patients in comparison to the blank control group [mean difference=-0.40, 95%confidence interval (-1.34-0.54), P=0.40]. Owing to the sample limitations of our study, it is hard for us to draw a conclusion that the application of neuromuscular electrical stimulation in managing pain in patients with knee osteoarthritis is of little significance. Further work based on large-sample and high-quality randomized control ed trials is needed to determine the role of neuromuscular electrical stimulation in pain in this population.

Applications of real-time three-dimensional transesophageal ultrasound technology in the diagnosis and treatment of artificial mitral paravalvular leak / 实用医学杂志

Objective To assess the application values of real-time three-dimensional transesophageal ultrasound (RT3D-TEE) technology in the diagnosis and treatment of artificial mitral paravalvular leak (PVL). Methods Fifty-one cases of artificial mitral PVL patients were received two-dimensional transesophageal ultrasound (2D-TEE) and RT3D-TEE examination before and after surgery. Accuracy analysis was performed between the two kinds of test. Results The diagnostic accuracy of RT3D-TEE technique in patients with PVL drain port positionwas significantly higher than that of 2D-TEE technology , and the data of PVL drain port size by RT3D-TEE technique is significantly larger than that of 2D-TEE technique (P < 0.05, respectively). Conclusion The PVL laboratory diagnosis based on RT3D-TEE is accurate and reliable , and RT3D-TEE can assist doctors to diagnose before operation , and can provide real-time ultrasound information from intraoperative monitoring , and monitor the postoperative efficacy of patients .

Study of the shape and function of right atrium in patients with chronic pulmonary hypertension and the influencing factors / 中华超声影像学杂志

Objective To assess the volume and function of right atrium(RA) in patients with chronic pulmonary hypertension(PH) by echocardiography and explore the influencing factors of these changes.Methods The study include 20 healthy participants as the control group and 57 patients with chronic PH as the case group.The patients were divided into three groups: low-grade PH, midrange PH and severe PH.Maximal RA volume index(VmaxI), minimal RA volume index(VminI), pre-atrial contraction RA volume index( VpreI), reservoir volume index(RVI), conduit volume index(CVI), contraction-chamber volume index (CCVI) were measured and calculated.The diameter of tricuspid valve and the late-diastole peak velocity of the bloodstream(Va) were measured,and then RA ejection force(RAEF) could be calculated.Systolic strain rate(RASRs), early diastolic strain rate (RASRe), and late diastolic strain rate (RASRa) of RA free wall were measured respectively.The correlation between pulmonary arterial systolic pressure (PASP), right ventricular ejection fraction(RVEF),the tissue Doppler of RV free wall(Ea/Aa) and the parameters of RA were analysed,and the main factors influencing the volume and function of RA were exploxed.Results With the rising of PASP, the RA volume changed obviously.And CCVI, RAEF, RVI, RASRs and the absolute value of RASRa increased gradually, but CVI decreased gradually.PASP, RVEF and Ea/Aa correlated with the parameters of RA.The main factors influencing the Vprel were EDVI, Ea/Aa and the course of disease,and VpreI and PASP mainly influenced the RAEF.Conclusions In patients with chronic PH the volume and function of RA changed,and some index of which was infuenced by PASP, RVEF, Ea/Aa and so on.

Effect of PCI on left ventricular diastolic function in the old people with acute myocardial infarction / 中国综合临床

Objective To compare the the effect of PCI on short term (3 months) left ventricular diastolic function in the old patients with acute myocardial infarction (AMI) (≥ 65 years old). Methods 40 old AMI patients were divided into PCI group and non-operation group (pure medicine treatment group). The changes of left ventricular diastolic function were observed 3 months after operation which were compared with that before treatment so to define the effect of PCI. The major indexes were LA, LV, LVEF, E/A, and S/D. Results LA and LV in PCI group were not significandy changes but they were increased in non-operation group (P < 0.05). Although the left ventricular diastolic function in both group was continually impaird,it was better in PCI group than in non-operation greup(P <0.05). Conclusion PCI can prolong the progress of left heart remodeling and the excerbation of left ventricular diastolic function in old AMI patients.