日间手术在髋膝关节置换的应用四川大学华西医院VIP免费

Same-DayDischargeinTotalJointArthroplastyMay,20182016级硕士研究生：罗泽宇研究生导师：周宗科教授ThedemandforTJAisincreasingFast-trackTJA:LOS<3daysOutpatient:−dischargedonsamedaypostoperative(lessthan12-hourstay)Financialanalysis−OutpatientTJAwouldsave$300millionannuallyIntroduction2009年2010年2011年2012年2013年2014年2015年2016年2017年012345678910111211.268.637.827.25.996.886.614.553.74TKALOS术后住院时间/天IntroductionSafetyisprimaryfactortobeconcerned−Complication,mortality,readmissionandreoperationRiskfactorandpatientselection−Generalcondition:age,gender,BMI−Historicalorcurrentdisease:diabetes,cardiacdisease,pulmonarydisease,renaldiseaseSurgicalprocedure−Generalorregionalorspinalanesthesia−Standardorminiincision−Tourniquet,drainagePerioperativemanagementanddischargePostoperativefunctionandrehabilitationArticle#12017.JBJSLevelofEvidenceLevelIIIRetrospectivestudyArticle#1Aim:tocomparematchedcohortsofpatientswhounderwentsame-dayandinpatienthiporkneearthroplastyintermsofpostoperativecomplicationsand30-dayreadmissionratesDesign:retrospectivematchedcohortsstudyDatasource:ACS-NSQIPregistryfrom517UShospitalfrom2005-2014Outcomes:complications,readmissionratesGeneralcharacter:−177,818patients,1,236outpatients,176,582inpatientsDemographicsAdverseeventsAdverseeventsinTHAAdverseeventsinTKAAdverseeventsinUKARiskfactorofcomplicationFactorsRelativerisk95%confidenceinterval(CI)PvalueBMI>35kg/m22.391.06-5.400.035insulin-dependentdiabetes4.021.06-15.300.041non-insulin-dependentdiabetes3.271.29-8.340.013Age>855.361.09-23.330.039ConclusionNosignificantdifferencesinoverallpostoperativecomplicationsorreadmissionwerefoundbetweenmatchedcohortsofpatientswhounderwentsame-dayandinpatienthipandkneearthroplastiesLimitationsRetrospectivestudyThefunctionwasnotassessedRiskFactorsforComplicationsandreadmissionshouldbegivenmoredetailsArticle#22017.JOALevelofEvidenceLevelIIIRetrospectivestudyArticle#2Aim:Tocomparethepredictiveabilityoftheriskassessmentof“OutpatientArthroplastyRiskAssessmentScore(OARA)”,“ASA”,“Charlsoncomorbidityindex(CCI)”Design:retrospectivestudyOutcomes:sensitivityofthescalesGeneralcharacter:−1120consecutiveTHAandTKApatients−MeanAge62.3yrs−MeanBMI32.4−521knees(53.2%)/458hips(46.8%)OARAscoreIndianauniversity9comorbidityareasLowrisk:OARA≤59Highrisk:OARA≥60OARAscoreJArthroplasty.2017Aug;32(8):2325-2331ThreescalesPositivepredictivevalueOARASCORE≤59dischargePOD0or1:81.6%ASA≤2dischargePOD0or1:56.4%CCI=0dischargePOD0or1:70.3%ConclusionCurrentmedicalselectioncriteriaforoutpatientTJA,suchasASA,arecrudeOARAScorerepresentsamoresensitivemedicalriskstratificationforoutpatientTJAArticle#32017.CORRLevelofEvidenceLevelIRandomizedstudyArticle#3Aim:Tocomparedischargedonthesamedayasthesurgery(‘‘outpatient,’’lessthan12-hourstay)withthosewhoaredischargedafteranovernighthospitalstay(‘‘inpatient’’)inTHAsDesign:Multicenter,RCTsOutcomes:postoperativepain;perioperativecomplications;readmissionGeneralcharacter:220patients,M/F117/103,age60.0±8.7y,BMI27.9±4.4kg/m2Inclusionandexclusioncriteria初次单侧THABMI<40Age<75HB>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PerioperativemanagementDirectanteriorapproachSpinalanesthesia24hoursofantibiotic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DemographicsGeneralcharacter:−220patients,M/F117/103,age60.0±8.7y,BMI27.9±4.4kg/m2NodifferencenotedbetweenthegroupsResultsOutpatientInpatientPvalueVASPON12.8±2.53.3±2.30.12VASPOD13.7±2.32.8±2.10.01VASPOW41.7±1.91.7±1.90.77HHSPOW475±1875±140.77Reoperation211Readmissions140.21Contactstostaff2.4±1.92.4±2.20.94OnlyVASPOD1notedasignificantdifferencebetweenthegroupConclusionOutpatientTHAcanbecomparablewithinpatientwithastrictinclusionanddischargecriteriaLimitationsOnly220THAswereevaluatedTheapplicationsofbloodmanagement,drainageandrehabilitationwerenotgivenThecostofpatientswasnotevaluatedTakehomemessageOutpatientsTJAwerecomparablewithinpatientinselectedsurgeryinsafetyandcomplicationsOutpatientsTJAcanreducetheLOSandwerecostsavingOutpatientArthroplastyRiskAssessment(OARA)scorewasneededinriskstratificationAstrictdischargecriteriashouldbemeetbeforedischargeRehabilitationandfunctionshouldbeassessedinfutureresearchPerioperativemanagement,surgicalandanesthesiatechnologyshouldbeoptimalThanksforyourattention！