Bohu Y, Klouche S, Gerometta A, Herman S, Lefevre N
Clinique du sport Paris V, 75005 Paris, France; Institut de l'appareil locomoteur Nollet, 75017 Paris, France.
Clinique du sport Paris V, 75005 Paris, France; Institut de l'appareil locomoteur Nollet, 75017 Paris, France.
Orthop Traumatol Surg Res. 2016 Jun;102(4):507-12. doi: 10.1016/j.otsr.2015.12.019. Epub 2016 Mar 2.
Some surgical procedures are rarely done on an outpatient basis. The primary objective of this study was to assess the safety of outpatient surgical shoulder stabilisation using the Latarjet procedure.
The Latarjet procedure is safe when performed on an outpatient basis provided the patients are managed according to a specifically designed programme starting at the decision to undergo surgery and ending at the end of the early postoperative period.
Consecutive patients with unidirectional anterior shoulder instability managed in 2013-2014 by primary open, minimally invasive surgery involving coracoid process transfer as described by Latarjet was included prospectively. One of the surgeons routinely offered outpatient surgery to patients who met none of the usual exclusion criteria (age>60years, ASA 3-4, and long distance from home to hospital). Standardised protocols were applied for anaesthesia and analgesia. The primary evaluation criterion was failure of the admission modality, defined as inpatient admission of a patient after outpatient surgery either without prior discharge or within 1week after discharge. Secondary evaluation criteria were early postoperative symptoms and functional outcomes after at least 1year. All self-reported criteria were entered online by the patients.
Of 46 included patients, 17 had outpatient surgery and 29 inpatient surgery. There were 41 males and 5 females, with a mean age of 25.3±6.4years. No significant baseline differences were found between the two groups. None of the outpatients required inpatient admission or readmission. No postoperative complications were recorded. After a mean follow-up of 18.5±5.2months, the two groups showed no significant differences for return to sports, apprehension, avoidance behaviours, or functional outcomes. Most patients were satisfied with their management and outcomes.
No serious adverse events were recorded in this first French prospective evaluation of the safety of open, minimally invasive shoulder stabilisation by the Latarjet procedure performed on an outpatient basis. Thus, in selected patients, the risks of outpatient surgery are similar to those of inpatient surgery.
III, prospective, comparative, non-randomised study.
一些外科手术很少在门诊进行。本研究的主要目的是评估采用Latarjet手术进行门诊手术治疗肩部稳定的安全性。
如果患者按照从决定接受手术开始到术后早期结束的专门设计方案进行管理，那么在门诊进行Latarjet手术是安全的。
前瞻性纳入2013年至2014年期间采用如Latarjet所描述的涉及喙突转移的初次开放、微创手术治疗的单向性肩关节前脱位连续患者。其中一位外科医生常规为不符合任何常规排除标准（年龄>60岁、美国麻醉医师协会分级3 - 4级、家离医院距离远）的患者提供门诊手术。麻醉和镇痛采用标准化方案。主要评估标准是入院方式失败，定义为门诊手术后患者未经事先出院或出院后1周内再次住院。次要评估标准是术后早期症状和至少1年后的功能结局。所有自我报告的标准均由患者在线录入。
纳入的46例患者中，17例行门诊手术，29例行住院手术。男性41例，女性5例，平均年龄25.3±6.4岁。两组之间未发现显著的基线差异。门诊患者均无需住院或再次入院。未记录到术后并发症。平均随访18.5±5.2个月后，两组在恢复运动、恐惧、回避行为或功能结局方面无显著差异。大多数患者对其治疗和结局满意。
在法国首次对采用Latarjet手术进行门诊开放、微创手术治疗肩部稳定安全性的前瞻性评估中，未记录到严重不良事件。因此，对于选定的患者，门诊手术的风险与住院手术相似。
III级，前瞻性、比较性、非随机研究。
