2022年医学专题-日间手术在髋膝关节置换的应用1-四川大学华西医院

Same-DayDischargeinTotalJointArthroplastyMay,

20182016级硕士(shuòshì)研究生：罗泽宇研究生导师：周宗科教授第一页，共三十二页。ThedemandforTJAisincreasingFast-trackTJA:LOS<3daysOutpatient:dischargedonsamedaypostoperative(lessthan12-hourstay)FinancialanalysisOutpatientTJAwouldsave$300millionannuallyIntroduction第二页，共三十二页。IntroductionSafetyisprimaryfactortobeconcernedComplication,

mortality,readmissionandreoperationRiskfactorandpatientselectionGeneralcondition:age,gender,BMIHistoricalorcurrentdisease:diabetes,cardiacdisease,pulmonarydisease,renaldiseaseSurgicalprocedureGeneralorregionalorspinalanesthesiaStandardorminiincisionTourniquet,drainagePerioperativemanagementanddischargePostoperativefunction

andrehabilitation第三页，共三十二页。Article#12017.JBJSLevelofEvidenceLevelIIIRetrospectivestudy第四页，共三十二页。Article#1Aim:tocomparematchedcohortsofpatientswhounderwentsame-dayandinpatienthiporkneearthroplastyintermsofpostoperativecomplicationsand30-dayreadmissionratesDesign:retrospectivematchedcohortsstudyDatasource:ACS-NSQIPregistryfrom517UShospitalfrom2005-2014Outcomes:complications,readmissionratesGeneralcharacter:177,818

patients,

1,236

outpatients,176,582inpatients第五页，共三十二页。Demographics第六页，共三十二页。Adverseevents第七页，共三十二页。AdverseeventsinTHA第八页，共三十二页。AdverseeventsinTKA第九页，共三十二页。AdverseeventsinUKA第十页，共三十二页。RiskfactorofcomplicationFactorsRelativerisk95%confidenceinterval(CI)PvalueBMI>35kg/m22.39

1.06-5.400.035insulin-dependentdiabetes4.021.06-15.300.041non-insulin-dependentdiabetes3.271.29-8.340.013Age>855.361.09-23.330.039第十一页，共三十二页。ConclusionNosignificantdifferencesinoverallpostoperativecomplicationsorreadmissionwerefoundbetweenmatchedcohortsofpatientswhounderwentsame-dayandinpatienthipandkneearthroplasties

第十二页，共三十二页。LimitationsRetrospectivestudyThefunctionwasnotassessedRiskFactorsforComplicationsandreadmissionshouldbegivenmoredetails

第十三页，共三十二页。Article#22017.JOALevelofEvidenceLevelIIIRetrospectivestudy第十四页，共三十二页。Article#2Aim:Tocomparethepredictiveabilityoftheriskassessmentof“OutpatientArthroplastyRiskAssessmentScore(OARA)”,“ASA”,“Charlsoncomorbidityindex(CCI)”Design:retrospectivestudyOutcomes:sensitivityofthescalesGeneralcharacter:1120consecutiveTHAandTKApatientsMeanAge62.3yrsMeanBMI32.4521knees(53.2%)/458hips(46.8%)

第十五页，共三十二页。OARAscoreIndianauniversity9comorbidityareasLowrisk:OARA≤59Highrisk:OARA≥60

第十六页，共三十二页。OARAscoreJArthroplasty.2017Aug;32(8):2325-2331第十七页，共三十二页。Threescales第十八页，共三十二页。PositivepredictivevalueOARASCORE≤59dischargePOD0or1:

81.6%ASA≤2dischargePOD0or1:

56.4%CCI=0dischargePOD0or1:

70.3%

第十九页，共三十二页。ConclusionCurrentmedicalselectioncriteriaforoutpatient

TJA,suchasASA,arecrude

OARAScorerepresentsamoresensitivemedicalriskstratificationforoutpatientTJA

第二十页，共三十二页。Article#32017.CORRLevelofEvidenceLevelIRandomizedstudy第二十一页，共三十二页。Article#3Aim:Tocomparedischargedonthesamedayasthesurgery(‘‘outpatient,’’lessthan12-hourstay)withthosewhoaredischargedafteranovernighthospitalstay(‘‘inpatient’’)inTHAsDesign:Multicenter,RCTsOutcomes:postoperativepain;perioperativecomplications;readmissionGeneralcharacter:220patients,M/F117/103,age60.0±8.7y,BMI27.9±4.4kg/m2第二十二页，共三十二页。Inclusionandexclusioncriteria初次单侧THABMI<40Age<75HB>10g/dL无心肺疾病术前不需轮椅术前不长期鸦片(yāpiàn)镇痛术后回家有良好照看第二十三页，共三十二页。PerioperativemanagementDirectanteriorapproachSpinalanesthesia24hoursofantibiotic

曲马多酮咯酸普瑞巴林(bālín)塞来昔布氢化可的松磺胺(huánɡàn)过敏第二十四页，共三十二页。Dischargecriteria走80英尺上下楼知晓家庭康复上厕所独立起床独立日常活动术后小便固体食物疼痛控制良好生命体征平稳(píngwěn)无晕眩或呕吐良好的家庭照顾

第二十五页，共三十二页。DemographicsGeneralcharacter:220patients,M/F117/103,age60.0±8.7y,BMI27.9±4.4kg/m2Nodifferencenotedbetweenthegroups第二十六页，共三十二页。ResultsOutpatientInpatientPvalueVASPON12.8±2.53.3±2.30.12

VASPOD13.7±2.32.8±2.1

0.01VASPOW41.7±1.9

1.7±1.9

0.77HHSPOW475±1875±140.77Reoperation211Readmissions140.21Contactstostaff2.4±1.9

2.4±2.2

0.94OnlyVASPOD1notedasignificantdifferencebetweenthegroup第二十七页，共三十二页。ConclusionOutpatientTHAcanbecomparablewithinpatientwithastrictinclusionanddischargecriteria

第二十八页，共三十二页。LimitationsOnly220THAswereevaluatedTheapplicationsofbloodmanagement,drainageandrehabilitationwerenotgivenThecostofpatientswasnotevaluated第二十九页，共三十二页。TakehomemessageOutpatientsTJAwerecomparablewithinpatientinselectedsurgeryinsafetyandcomplicationsOutpatientsTJAcanreducetheLOSandwerecostsavingOutpatientArthroplastyRiskAssessment(OARA)scorewasneededinriskstratificationAstrictdischargecriteriashouldbemeetbeforedischargeRehabilitationandfunctionshouldbeassessedinfutureresearchPerioperativemanagement,surgicalandanesthesiatechnologyshouldbeoptimal第三十页，共三