醫(yī)學知識一日間手術在髖膝關節(jié)置換的應用1一四川大學華西醫(yī)院

Same-DayDischargeinTotalJointArthroplastyMay,

20182016級碩士研究生：羅澤宇研究生導師：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初次單側THABMI<40Age<75HB>10g/dL無心肺疾病術前不需輪椅術前不長期鴉片鎮(zhèn)痛術后回家有良好照看PerioperativemanagementDirectanteriorapproachSpinalanesthesia24hoursofantibiotic

曲馬多酮咯酸普瑞巴林塞來昔布氫化可的松磺胺過敏Dischargecriteria走80英尺上下樓知曉家庭康復上廁所獨立起床獨立日常活動術后小便固體食物疼痛控制良好生命體征平穩(wěn)無暈?；驀I吐良好的家庭照顧

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