Rozell Joshua C, Courtney P Maxwell, Dattilo Jonathan R, Wu Chia H, Lee Gwo Chin
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
J Arthroplasty. 2017 Mar;32(3):719-723. doi: 10.1016/j.arth.2016.08.037. Epub 2016 Sep 1.
Improved pain management and early mobilization protocols have increased interest in the feasibility of short stay (<24 hours) or outpatient total hip (THA) and total knee (TKA) arthroplasty. However, concerns exist regarding patient safety and readmissions. The purposes of this study were to determine the incidence of in-hospital complications following THA/TKA, to create a model to identify comorbidities associated with the risk of developing major complications >24 hours postoperatively, and to validate this model against another consecutive series of patients.
We prospectively evaluated a consecutive series of 802 patients who underwent elective primary THA and TKA over a 9-month period. The mean age was 62.3 years. Demographic, surgical, and postoperative readmission data were entered into an arthroplasty database.
Of the 802 patients, 382 experienced a complication postoperatively. Of these, 152 (19%) required active management. Multiple logistic regression analysis identified cirrhosis (odds ratio [OR], 5.89; 95% confidence interval [CI], 1.05-33.07; P = .044), congestive heart failure (OR, 3.12; 95% CI, 1.50-6.44; P = .002), and chronic kidney disease (OR, 3.85; 95% CI, 2.21-6.71; P < .001) as risk factors for late complications. One comorbidity was associated with a 77% probability of developing a major postoperative complication. This model was validated against an independent dataset of 1012 patients.
With improved pain management and mobilization protocols, there is increasing interest in short stay and outpatient THA and TKA. Patients with cirrhosis, congestive heart failure, or chronic kidney disease should be excluded from early discharge total joint arthroplasty protocols.
改进的疼痛管理和早期活动方案使人们对短期住院（<24小时）或门诊全髋关节置换术（THA）和全膝关节置换术（TKA）的可行性兴趣增加。然而，患者安全性和再入院问题令人担忧。本研究的目的是确定THA/TKA术后院内并发症的发生率，建立一个模型以识别与术后>24小时发生主要并发症风险相关的合并症，并针对另一组连续患者验证该模型。
我们前瞻性评估了在9个月期间接受择期初次THA和TKA的802例连续患者。平均年龄为62.3岁。人口统计学、手术和术后再入院数据被录入关节置换数据库。
802例患者中，382例术后出现并发症。其中，152例（19%）需要积极处理。多因素logistic回归分析确定肝硬化（比值比[OR]，5.89；95%置信区间[CI]，1.05 - 33.07；P = .044）、充血性心力衰竭（OR，3.12；95%CI，1.50 - 6.44；P = .002）和慢性肾脏病（OR，3.85；95%CI，2.21 - 6.71；P < .001）为晚期并发症的危险因素。一种合并症与术后发生主要并发症的概率77%相关。该模型在1012例患者的独立数据集中得到验证。
随着疼痛管理和活动方案的改进，人们对短期住院和门诊THA及TKA的兴趣日益增加。肝硬化、充血性心力衰竭或慢性肾脏病患者应排除在早期出院全关节置换术方案之外。
