Gromov Kirill, Kjærsgaard-Andersen Per, Revald Peter, Kehlet Henrik, Husted Henrik
a Department of Orthopedic Surgery , Copenhagen University Hospital , Hvidovre.
d Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty , Denmark.
Acta Orthop. 2017 Oct;88(5):516-521. doi: 10.1080/17453674.2017.1314158. Epub 2017 Apr 20.
Background and purpose - The number of patients who are suitable for outpatient total hip and knee arthroplasty (THA and TKA) in an unselected patient population remains unknown. The purpose of this prospective 2-center study was to identify the number of patients suitable for outpatient THA and TKA in an unselected patient population, to investigate the proportion of patients who were discharged on the day of surgery (DOS), and to identify reasons for not being discharged on the DOS. Patients and methods - All consecutive, unselected patients who were referred to 2 participating centers and who were scheduled for primary THA and TKA were screened for eligibility for outpatient surgery with discharge to home on DOS. If patients did not fulfill the discharge criteria, the reasons preventing discharge were noted. Odds factors with relative risk intervals for not being discharged on DOS were identified while adjusting for age, sex, ASA score, BMI and distance to home. Results - Of the 557 patients who were referred to the participating surgeons during the study period, 54% were potentially eligible for outpatient surgery. Actual DOS discharge occurred in 13-15% of the 557 patients. Female sex and surgery late in the day increased the odds of not being discharged on the DOS. Interpretation - This study shows that even in unselected THA and TKA patients, same-day discharge is feasible in about 15% of patients. Future studies should evaluate safety aspects and economic benefits.
背景与目的——在未经过筛选的患者群体中，适合门诊全髋关节置换术（THA）和全膝关节置换术（TKA）的患者数量尚不清楚。这项前瞻性双中心研究的目的是确定未经过筛选的患者群体中适合门诊THA和TKA的患者数量，调查手术当日（DOS）出院的患者比例，并确定未在DOS出院的原因。患者与方法——所有连续的、未经过筛选的被转诊至两个参与中心并计划接受初次THA和TKA的患者，均接受门诊手术资格筛查，目标是在DOS出院回家。如果患者不符合出院标准，则记录阻止出院的原因。在对年龄、性别、美国麻醉医师协会（ASA）评分、体重指数（BMI）和住家距离进行校正的同时，确定未在DOS出院的比值比及相对风险区间。结果——在研究期间被转诊至参与手术的外科医生处的557例患者中，54%可能适合门诊手术。在这557例患者中，13% - 15%在实际DOS出院。女性以及手术时间较晚增加了未在DOS出院的几率。解读——本研究表明，即使在未经过筛选的THA和TKA患者中，约15%的患者在同一天出院是可行的。未来的研究应评估安全性和经济效益。
