全膝关节置换术的强化康复计划以缩短住院时间。

Enhanced recovery programme for total knee replacement to reduce the length of hospital stay.

作者信息

Dwyer Amitabh J, Thomas William, Humphry Simon, Porter Paul

机构信息

Department of Trauma and Orthopaedic Surgery, Yeovil District Hospital, Somerset, United Kingdom.

出版信息

J Orthop Surg (Hong Kong). 2014 Aug;22(2):150-4. doi: 10.1177/230949901402200206.

DOI:10.1177/230949901402200206

PMID:25163944

Abstract

PURPOSE

To compare the length of hospital stay in patients undergoing primary total knee replacement (TKR) with or without enhanced recovery (ER) programme.

METHODS

Medical records of 57 and 55 consecutive patients who underwent primary TKR with or without ER programme, respectively, were reviewed. 17 men and 40 women aged 43 to 87 (mean, 70) years with ER programme were compared with 22 men and 33 women aged 53 to 90 (mean, 73) years without ER programme in terms of the preoperative haemoglobin level, American Association of Anesthesiologists (ASA) physical status grading, body mass index (BMI), and length of hospital stay.

RESULTS

The length of hospital stay was significantly shorter in the ER than non-ER groups in overall patients (6 vs. 7.8 days, p=0.0003), in patients with preoperative haemoglobin level of ≥ 14 g/dl (5.4 vs. 7.7 days, p=0.02), in patients with preoperative haemoglobin level of <14 g/dl (6.2 vs. 7.7 days, p=0.02), in patients with ASA grades 1 and 2 (5.6 vs. 7.6 days, p=0.01), in patients with ASA grade 3 (6.4 vs. 8.2 days, p=0.01), in patients with BMI of <30 kg/m(2) (6 vs. 8.1 days, p=0.0061), and in patients with BMI of ≥ 30 kg/m(2) (5.9 vs. 7.5 days, p=0.0006). Complications were noted in 4 ER patients and 5 non-ER patients.

CONCLUSION

ER programmes are readily transferable to patients undergoing TKR and significantly reduced the length of hospital stay.

摘要

目的

比较接受初次全膝关节置换术（TKR）的患者采用或未采用强化康复（ER）方案时的住院时间。

方法

回顾了分别采用或未采用ER方案进行初次TKR的57例和55例连续患者的病历。将17例男性和40例年龄在43至87岁（平均70岁）采用ER方案的女性与22例男性和33例年龄在53至90岁（平均73岁）未采用ER方案的女性在术前血红蛋白水平、美国麻醉医师协会（ASA）身体状况分级、体重指数（BMI）和住院时间方面进行比较。

结果

在总体患者中（6天对7.8天，p = 0.0003），术前血红蛋白水平≥14 g/dl的患者中（5.4天对7.7天，p = 0.02），术前血红蛋白水平<14 g/dl的患者中（6.2天对7.7天，p = 0.02），ASA 1级和2级的患者中（5.6天对7.6天，p = 0.01），ASA 3级的患者中（6.4天对8.2天，p = 0.01），BMI<30 kg/m²的患者中（6天对8.1天，p = 0.0061），以及BMI≥30 kg/m²的患者中（5.9天对7.5天，p = 0.0006），ER组患者的住院时间明显短于非ER组。4例采用ER方案的患者和5例未采用ER方案的患者出现了并发症。