Berger Richard A, Sanders Sheila A, Thill Elizabeth S, Sporer Scott M, Della Valle Craig
Department of Orthopaedic Surgery, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612, USA.
Clin Orthop Relat Res. 2009 Jun;467(6):1424-30. doi: 10.1007/s11999-009-0741-x. Epub 2009 Feb 28.
Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consecutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices. Thirty-eight patients required some additional intervention outside the pathway to resolve nausea, hypotension, or sedation prior to discharge. There were no readmissions for pain, nausea, or hypotension yet there was one readmission for fracture and nine emergency room evaluations in the three month perioperative period. This anesthetic and rehabilitation protocol allowed outpatient total hip arthroplasty to be routinely performed in these consecutive patients undergoing primary total hip arthroplasty. With current reimbursement approaches the modest savings to the hospital in length of stay may be outweighed by the additional costs of personnel, thereby making this outpatient system more expensive to implement.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
手术方法、麻醉技术的进步以及快速康复方案的启动，已缩短了择期全髋关节置换术后的住院时间和后续恢复时长。我们评估了150例连续患者门诊全髋关节置换术的可行性和安全性。围绕微创外科技术实施了一项全面的围手术期麻醉和康复方案，包括术前宣教、区域麻醉以及预防性口服镇痛和止吐治疗。术后立即启动快速康复路径，若符合标准出院标准，患者可选择在手术当天出院回家。所有150例患者均在手术当天出院，此时131例患者能够无需辅助设备行走。38例患者在出院前需要在路径之外进行一些额外干预以解决恶心、低血压或镇静问题。在围手术期的三个月内，没有因疼痛、恶心或低血压再次入院的情况，但有1例因骨折再次入院，9例在急诊室接受评估。这种麻醉和康复方案使门诊全髋关节置换术能够在这些接受初次全髋关节置换术的连续患者中常规开展。按照目前的报销方式，住院时间的适度节省可能会被人员的额外成本所抵消，从而使得这种门诊系统的实施成本更高。
IV级，治疗性研究。有关证据级别的完整描述，请参阅作者指南。
