医学知识一日间手术在髋膝关节置换的应用1一四川大学华西医院

Same-DayDischargeinTotalJointArthroplastyMay,

20182016级硕士研究生：罗泽宇研究生导师：周宗科教授ThedemandforTJAisincreasingFast-trackTJA:LOS<3daysOutpatient:dischargedonsamedaypostoperative(lessthan12-hourstay)FinancialanalysisOutpatientTJAwouldsave$300millionannuallyIntroductionIntroductionSafetyisprimaryfactortobeconcernedComplication,

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

andrehabilitationArticle#12017.JBJSLevelofEvidenceLevelIIIRetrospectivestudyArticle#1Aim:tocomparematchedcohortsofpatientswhounderwentsame-dayandinpatienthiporkneearthroplastyintermsofpostoperativecomplicationsand30-dayreadmissionratesDesign:retrospectivematchedcohortsstudyDatasource:ACS-NSQIPregistryfrom517UShospitalfrom2005-2014Outcomes:complications,readmissionratesGeneralcharacter:177,818

patients,

1,236

outpatients,176,582inpatientsDemographicsAdverseeventsAdverseeventsinTHAAdverseeventsinTKAAdverseeventsinUKARiskfactorofcomplicationFactorsRelativerisk95%confidenceinterval(CI)PvalueBMI>35kg/m22.39

1.06-5.400.035insulin-dependentdiabetes4.021.06-15.300.041non-insulin-dependentdiabetes3.271.29-8.340.013Age>855.361.09-23.330.039ConclusionNosignificantdifferencesinoverallpostoperativecomplicationsorreadmissionwerefoundbetweenmatchedcohortsofpatientswhounderwentsame-dayandinpatienthipandkneearthroplasties

LimitationsRetrospectivestudyThefunctionwasnotassessedRiskFactorsforComplicationsandreadmissionshouldbegivenmoredetails

Article#22017.JOALevelofEvidenceLevelIIIRetrospectivestudyArticle#2Aim:Tocomparethepredictiveabilityoftheriskassessmentof“OutpatientArthroplastyRiskAssessmentScore(OARA)”,“ASA”,“Charlsoncomorbidityindex(CCI)”Design:retrospectivestudyOutcomes:sensitivityofthescalesGeneralcharacter:1120consecutiveTHAandTKApatientsMeanAge62.3yrsMeanBMI32.4521knees(53.2%)/458hips(46.8%)

OARAscoreIndianauniversity9comorbidityareasLowrisk:OARA≤59Highrisk:OARA≥60

OARAscoreJArthroplasty.2017Aug;32(8):2325-2331ThreescalesPositivepredictivevalueOARASCORE≤59dischargePOD0or1:

81.6%ASA≤2dischargePOD0or1:

56.4%CCI=0dischargePOD0or1:

70.3%

ConclusionCurrentmedicalselectioncriteriaforoutpatient

TJA,suchasASA,arecrude

OARAScorerepresentsamoresensitivemedicalriskstratificationforoutpatientTJA

Article#32017.CORRLevelofEvidenceLevelIRandomizedstudyArticle#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/m2Inclusionandexclusioncriteria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镇痛术后回家有良好照看PerioperativemanagementDirectanteriorapproachSpinalanesthesia24hoursofantibiotic

曲马多酮咯酸普瑞巴林塞来昔布氢化可的松磺胺过敏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无晕眩或呕吐良好的家庭照顾

DemographicsGeneralcharacter:220patients,M/F117/103,age60.0±8.7y,BMI27.9±4.4kg/m2NodifferencenotedbetweenthegroupsResultsOutpatientInpatientPvalueVASPON12.8±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

0.94OnlyVASPOD1notedasignificantdifferencebetweenthegroupConclusionOutpatientTHAcanbecomparablewithinpatientwithastrictinclusionanddischargecriteria

LimitationsOnly220THAswereevaluatedTheapplicationsofbloodmanagement,drainageandrehabilitationwerenotgivenThecostofpatientswasnotevaluatedTakehomemessageOutpatientsTJAwerecomparablewithinpatientinselectedsurgeryinsafetyandcomplicationsOutpatientsTJAcanreducetheLOSandwerecostsavingOutpatientArthroplastyRiskAssessment(OARA)scorewasneededinriskstra