Survival Following Total Hip Replacement
Notice bibliographique
Résumé
BACKGROUND: Several studies have shown that patients who undergo total hip replacement live longer than control subjects, but the reason for this apparent protective effect is not clear. The purpose of our investigation was to assess whether the association had the characteristics of a causal relationship or whether it might appear to be due to comorbidity or other factors. METHODS: We compared survival over a six-year period for 28,469 Medicare enrollees who had elective primary total hip replacement in 1996 and a control group from the general Medicare population, matched 5:1 on year of birth, sex, race, and whether the Medicaid program paid the Medicare premium (a proxy for low income). For both the patients treated with total hip replacement and the control subjects, we used Medicare hospital claims to ascertain comorbidity, that is, whether the patient had had any of sixteen serious discharge diagnoses in the year prior to the total hip replacement (or an equivalent date for the controls). The survival patterns for the total hip arthroplasty and control cohorts were compared with use of proportional hazards regression for three follow-up periods: the first ninety days after surgery (or an equivalent date for the controls), ninety days to five years after surgery, and more than five years after surgery. RESULTS: The total hip replacement cohort had less comorbidity than the controls, with an approximately 30% lower prevalence for most serious diseases. Sex, age, Medicaid eligibility, and earlier serious comorbid diagnoses were important predictors of survival, but, even in analyses that adjusted for these variables, the total hip replacement cohort had better long-term survival than the controls. The patients who had a total hip replacement had a higher rate of mortality than the controls immediately after surgery, but, by three months postoperatively, the mortality rate for the patients was well below that for the controls. The overall rate of survival during the first ninety days was comparable for the two groups. From three months to five years after surgery, the mortality rate for the patients who had a total hip replacement was only two-thirds of that for the controls. After five years, the mortality rates for the two groups appeared to be converging. CONCLUSIONS: Total hip replacement recipients survive longer than do matched controls in the Medicare population. The very rapid emergence of the lower mortality rate suggests that it is due to the selection of low-risk patients for elective surgery. However, our admittedly crude adjustment for comorbidity did not diminish the protective effect, so some effect of the procedure itself cannot be ruled out.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».