下肢关节置换术的综合护理路径：它们是否能有效缩短住院时间？
Integrated care pathways in lower-limb arthroplasty: are they effective in reducing length of hospital stay?
机构信息
Department of Trauma and Orthopaedics, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
出版信息
Int Orthop. 2013 Jun;37(6):1157-63. doi: 10.1007/s00264-013-1829-1. Epub 2013 Mar 3.
PURPOSE
The aim of this study was to examine the effect of an integrated care pathway (ICP) for total hip and knee arthroplasty (THA/TKA) on length of stay (LOS), day of surgery admission rate (DOSA) and postoperative length of stay (POLOS).
METHODS
Three hundred and eight THAs and 299 TKAs were assessed in a retrospective before-after trial design. LOS, POLOS and DOSA were recorded for patients before and after introduction of the ICP. The ICP encompassed a patient education programme, specific daily management goals, variance mapping, daily facilitated meetings and a DOSA policy. Subgroup analysis according to age and gender was also performed.
RESULTS
Mean LOS was significantly reduced by 1.4 (from 6.9 to 5.5) days for THA and 0.8 (from 6.4 to 5.6) days for TKA. Elderly patients and men achieved greater LOS reductions than their counterparts for both operations. Younger patients undergoing THA achieved a significantly higher DOSA rate than older patients (89 % vs 71 %, p = 0.010); however, this difference was not observed in the TKA population. Mean POLOS for THA was reduced by 0.6 (from 5.9 to 5.3) days, again with the greatest benefit seen in elderly and male patients. POLOS for TKA patients was not significantly affected by the ICP.
CONCLUSIONS
The introduction of an ICP reduced LOS by 1.4 days for THA and 0.8 days for TKA. Elderly and male patients benefitted most.
目的
本研究旨在探讨全髋关节和膝关节置换术（THA/TKA）综合护理路径（ICP）对住院时间（LOS）、手术日入院率（DOSA）和术后住院时间（POLOS）的影响。
方法
采用回顾性前后试验设计，评估了 308 例 THA 和 299 例 TKA。在引入 ICP 前后记录患者的 LOS、POLOS 和 DOSA。ICP 包括患者教育计划、特定的日常管理目标、变异映射、每日促进会议和 DOSA 政策。还根据年龄和性别进行了亚组分析。
结果
THA 的 LOS 平均减少 1.4 天（从 6.9 天降至 5.5 天），TKA 的 LOS 平均减少 0.8 天（从 6.4 天降至 5.6 天）。两种手术中，老年患者和男性患者的 LOS 减少幅度均大于其对应患者。接受 THA 的年轻患者的 DOSA 率明显高于老年患者（89%比 71%，p=0.010）；然而，在 TKA 人群中并未观察到这种差异。THA 的 POLOS 平均减少 0.6 天（从 5.9 天降至 5.3 天），老年和男性患者的获益最大。TKA 患者的 POLOS 未受 ICP 显著影响。
结论
引入 ICP 使 THA 的 LOS 减少 1.4 天，TKA 的 LOS 减少 0.8 天。老年和男性患者受益最大。
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