Nelson Stephen J, Webb Matthew L, Lukasiewicz Adam M, Varthi Arya G, Samuel Andre M, Grauer Jonathan N
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
J Arthroplasty. 2017 May;32(5):1439-1442. doi: 10.1016/j.arth.2016.11.053. Epub 2016 Dec 14.
Safety data for outpatient total hip arthroplasty (THA) remains scarce.
The present study retrospectively reviews prospectively collected data from the 2005-2014 American College of Surgeons National Surgical Quality Improvement Program Database. Patients who underwent THA were categorized by day of hospital discharge to be outpatient (length of stay [LOS] 0 days) or inpatient (LOS 1-5 days). Those with extended LOS beyond 5 days were excluded. To account for baseline nonrandom assignment between the study groups, propensity score matching was used. The propensity matched populations were then compared with multivariate Poisson regression to compare the relative risks of adverse events during the initial 30 postoperative days including readmission.
A total of 63,844 THA patients were identified. Of these, 420 (0.66%) were performed as outpatients and 63,424 (99.34%) had LOS 1-5 days. Outpatients tended to be younger, male, and to have fewer comorbidities. After propensity score matching, outpatients had no difference in any of 18 adverse events evaluated other than blood transfusion, which was less for outpatients than those with a LOS of 1-5 days (3.69% vs 9.06%, P < .001).
After adjusting for potential confounders using propensity score matching and multivariate logistic regression, patients undergoing outpatient THA were not at greater risk of 30 days adverse events or readmission than those that were performed as inpatient procedures. Based on the general health outcome measures assessed, this data supports the notion that outpatient THA can appropriately be considered in appropriately selected patients.
门诊全髋关节置换术（THA）的安全性数据仍然匮乏。
本研究回顾性分析了前瞻性收集的2005年至2014年美国外科医师学会国家外科质量改进计划数据库中的数据。接受THA的患者根据出院日期分为门诊患者（住院时间[LOS]为0天）或住院患者（LOS为1 - 5天）。住院时间超过5天的患者被排除。为了考虑研究组之间的基线非随机分配，采用了倾向评分匹配。然后使用多变量泊松回归比较倾向匹配人群，以比较术后最初30天内包括再入院在内的不良事件的相对风险。
共识别出63,844例THA患者。其中，420例（0.66%）为门诊手术，63,424例（99.34%）住院时间为1 - 5天。门诊患者往往更年轻、为男性且合并症较少。倾向评分匹配后，除输血外，门诊患者在评估的18项不良事件中的任何一项上均无差异，门诊患者的输血发生率低于住院时间为1 - 5天的患者（3.69%对9.06%，P < .001）。
在使用倾向评分匹配和多变量逻辑回归调整潜在混杂因素后，接受门诊THA的患者在30天不良事件或再入院方面的风险并不高于住院手术患者。基于所评估的一般健康结局指标，该数据支持在适当选择的患者中可以适当考虑门诊THA这一观点。
