Argenson Jean-Noël A, Husted Henrik, Lombardi Adolph, Booth Robert E, Thienpont Emmanuel
Institute for Locomotion, Aix-Marseille University, Marseille, France
Department of Orthopedics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
J Bone Joint Surg Am. 2016 Jul 6;98(13):e55. doi: 10.2106/JBJS.15.00998.
Outpatient surgical procedures for adult hip and knee reconstruction are gaining interest on a worldwide basis and have been progressively increasing over the last few years. Preoperative screening needs to concentrate on both the patient's comorbidities and home environment to provide a proper alignment of expectations of the surgeon, the patient, and the patient's family. Preoperative multidisciplinary patient information covering all aspects of the upcoming treatment course is a mandatory step, focusing on pain management and early mobilization. Perioperative pain management includes both multimodal and preventive analgesia. Preemptive medications, minimization of narcotics, and combination of general and regional anesthesia are the techniques required in joint arthroplasty performed as an outpatient surgical procedure. A multimodal blood loss management program should be used with preoperative identification of anemia and attention directed toward minimizing blood loss, considering the use of tranexamic acid during the surgical procedure. Postoperative care extends from the initial recovery from anesthesia to the physical therapist's evaluation of the patient's ambulatory status. After the patient has met the criteria for discharge and has been discharged on the same day of the surgical procedure, a nurse should call the patient later at home to check on wound status, pain control, and muscle weakness, which will be further addressed by physiotherapy and education. Implementing outpatient arthroplasty requires monitoring safety, patient satisfaction, and economic impact.
成人髋膝关节重建的门诊手术在全球范围内越来越受到关注，并且在过去几年中一直在逐步增加。术前筛查需要关注患者的合并症和家庭环境，以便使外科医生、患者及其家属的期望达到合理一致。术前提供涵盖即将到来的治疗过程各个方面的多学科患者信息是必不可少的一步，重点是疼痛管理和早期活动。围手术期疼痛管理包括多模式镇痛和预防性镇痛。在门诊手术进行的关节置换术中，需要采用预防性用药、减少麻醉剂用量以及全身麻醉与区域麻醉相结合的技术。应使用多模式失血管理方案，术前识别贫血，并考虑在手术过程中使用氨甲环酸，以尽量减少失血。术后护理从麻醉后的初始恢复一直延伸到物理治疗师对患者步行状态的评估。在患者达到出院标准并在手术当天出院后，护士应在术后致电患者家中，检查伤口状况、疼痛控制和肌肉无力情况，这些问题将通过物理治疗和健康教育进一步解决。实施门诊关节置换术需要监测安全性、患者满意度和经济影响。
