Inpatient Versus Outpatient Arthroplasty: A Single-Surgeon, Matched Cohort Analysis of 90-Day Complications
Inpatient Versus Outpatient Arthroplasty: A Single-Surgeon, Matched Cohort Analysis of 90-Day Complications
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DOI：
10.1016/j.arth.2018.10.015
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发表时间：
2019-02-01
影响因子：
3.5
通讯作者：
Della Valle, Craig J.
中科院分区：
文献类型：
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作者：
Darrith, Brian;Frisch, Nicholas B.;Della Valle, Craig J.
背景：虽然先前的一些工作支持在医院进行当天关节置换手术的安全性，但当这些手术在独立的门诊手术中心进行时，人们仍然感到担忧。本研究的目的是比较在门诊手术中心接受关节置换术的住院患者和门诊患者的90天并发症发生率。方法：将243名连续接受门诊人工关节置换术的患者与243名接受相同手术的住院患者进行配对。在性别、年龄、美国麻醉师学会评分和体重指数方面进行一对一最近邻匹配。初次关节成形术486例，其中单髁178例(36.6%)，全髋关节146例(30.0%)，全膝关节92例(18.9%)，髋关节表面置换70例(14.5%)。90天的结果包括再次手术、再次住院、计划外门诊或急诊科就诊以及重大和轻微并发症，采用2样本比例检验进行比较。结果：两个队列在人口统计学变量的分布上相似，证明匹配成功。住院组和门诊组的再住院率均为2.1%(P=1.0)。随着研究对象的数量增加，主要并发症(2.1%比2.5%，P=1.0)、次要并发症(7.0%比7.8%，P=.86)、再次手术(0.4%比2.1%，P=.22)、急诊科就诊(1.6%比2.5%，P=.52)或计划外诊所就诊(3.3%比5.8%，P=0.52)的发生率没有统计学差异。结论：这项研究表明，在门诊手术中心选择适当的患者进行人工关节置换术是安全的，而且不会增加并发症的风险。(C)2018 Elsevier Inc.保留所有权利。
Background: Although some prior work supports the safety of same-day arthroplasty performed in a hospital, concerns remain when these procedures are performed in a free-standing ambulatory surgery center. The purpose of this study is to compare 90-day complication rates between matched cohorts that underwent inpatient vs outpatient arthroplasty at an ambulatory surgery center.Methods: A single-surgeon cohort of 243 consecutive patients who underwent outpatient arthroplasty was matched with 243 inpatients who had the same procedure. One-to-one nearest-neighbor matching with respect to gender, age, American Society of Anesthesiologists Score, and body mass index was utilized. The 486 primary arthroplasties included 178 unicondylar knees (36.6%), 146 total hips (30.0%), 92 total knees (18.9%), and 70 hip resurfacings (14.5%). Ninety-day outcomes including reoperation, readmission, unplanned clinic or emergency department visits, and major and minor complications were compared using a 2-sample proportions test.Results: The 2 cohorts were similar in distribution of demographic variables, demonstrating successful matching. The inpatient and outpatient cohorts both had readmission rates of 2.1% (P = 1.0). With the number of subjects studied, there were no statistically significant differences in rates of major complications (2.1% vs 2.5%, P = 1.0), minor complications (7.0% vs 7.8%, P = .86), reoperations (0.4% vs 2.1%, P = .22), emergency department visits (1.6% vs 2.5%, P = .52), or unplanned clinic visits (3.3% vs 5.8%, P = .19).Conclusion: This study suggests that arthroplasty procedures can be performed safely in an ambulatory surgery center among appropriately selected patients without an increased risk of complications. (C) 2018 Elsevier Inc. All rights reserved.