Transition to outpatient total hip and knee arthroplasty: experience at an academic tertiary care center.
Transition to outpatient total hip and knee arthroplasty: experience at an academic tertiary care center.
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DOI：
10.1016/j.artd.2018.10.008
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发表时间：
2019-03-01
影响因子：
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通讯作者：
Parvataneni, Hari K
中科院分区：
文献类型：
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作者：
Gogineni, Hrishikesh C;Gray, Chancellor F;Parvataneni, Hari K
背景：作为基于价值的护理和早期康复方案的一部分，门诊全髋关节置换术（THA）和全膝关节置换术（TKA）的兴趣最近有所增加。门诊途径需要重大的范式转变，并未广泛使用，并且主要在门诊手术中心或骨科专科医院实施。在本文中，我们报告了在三级医疗学术医疗中心实施门诊关节置换术方案的结果。方法：我们对按照我们新实施的门诊关节置换术方案接受 THA 或 TKA 的连续 105 例患者进行了回顾性评价。我们将这些患者与同一时期的一组住院关节置换术患者进行了比较。结果：105 名患者中有 83 名 (79%) 在手术当天成功出院回家。早期下床活动 (P= .01)、TKA 优于 THA (P= .04) 以及较短的手术时间 (P= .01) 可预测当天成功出院。全身麻醉与更好的早期下床活动距离 (P= .03) 和较低的尿潴留发生率 (P= .049) 相关。门诊患者再入院率和并发症率分别为 0.95% 和 1.9%，而匹配的住院患者率分别为 3.7% 和 2.9%。 结论：精心挑选的患者门诊 THA 和 TKA 在学术多学科三级护理医院是可行的，并发症发生率接近住院手术。本文报告的研究结果可用于进一步优化门诊关节置换术方案。
BACKGROUND: Interest in outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) has increased recently as part of value-based care and early recovery protocols. Outpatient pathways require significant paradigm shifts, are not used widely, and are mostly implemented at outpatient surgery centers or orthopedic specialty hospitals. In this article, we report on the outcomes of implementation of an outpatient arthroplasty protocol at a tertiary care academic medical center.METHODS: We performed a retrospective review on a series of 105 consecutive patients who underwent THA or TKA following our newly implemented outpatient arthroplasty protocol. We compared these patients to a group of inpatient arthroplasty patients from the same time period.RESULTS: Eighty-three of 105 (79%) patients were successfully discharged home on the day of surgery. Successful same-day discharge was predicted by early ambulation (P= .01), TKA over THA (P= .04), and shorter duration of surgery (P= .01). General anesthesia correlated with better early ambulation distances (P= .03) and a lower incidence of urinary retention (P= .049). The outpatient readmission and complication rates were 0.95% and 1.9%, respectively, whereas the matched inpatient rates were 3.7% and 2.9%, respectively.CONCLUSIONS: Outpatient THA and TKA in a well-selected patient is feasible in an academic multidisciplinary tertiary care hospital, with complication rates approximating inpatient surgery. The findings reported here can be used to further optimize outpatient arthroplasty protocols.