Lan Roy H, Kamath Atul F
College of Arts and Sciences, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Open Orthop J. 2017 Mar 22;11:195-202. doi: 10.2174/1874325001711010195. eCollection 2017.
Medical evaluation pre-operatively is an important component of risk stratification and potential risk optimization. However, the effect of timing prior to surgical intervention is not well-understood. We hypothesized that total hip arthroplasty (THA) patients seen in pre-operative evaluation closer to the date of surgery would experience better perioperative outcomes.
We retrospectively reviewed 167 elective THA patients to study the relationship between the number of days between pre-operative evaluation (range, 0-80 days) and surgical intervention. Patients' demographics, length of stay (LOS), ICU admission frequency, and rate of major complications were recorded.
When pre-operative evaluation carried out 4 days or less before the procedure date, there was a significant reduction in LOS (3.91 vs. 4.49; p=0.03). When pre-operative evaluation carried out 11 days or less prior to the procedure date, there was a four-fold decrease in rate of intensive care admission (p=0.04). Furthermore, the major complication rate also significantly reduced (p<0.05). However, when pre-operative evaluation took place 30 days or less before the procedure date compared to more than 30 days prior, there were no significant changes in the outcomes.
From this study, pre-operative medical evaluation closer to the procedure date was correlated with improved selected peri-operative outcomes. However, further study on larger patient groups must be done to confirm this finding. More study is needed to define the effect on rare events like infection, and to analyze the subsets of THA patients with modifiable risk factors that may be time-dependent and need further time to optimization.
术前医学评估是风险分层和潜在风险优化的重要组成部分。然而，手术干预前评估时间的影响尚未得到充分理解。我们假设，在术前评估中距离手术日期更近就诊的全髋关节置换术（THA）患者将获得更好的围手术期结局。
我们回顾性分析了167例择期THA患者，以研究术前评估（范围为0 - 80天）与手术干预之间的天数关系。记录患者的人口统计学数据、住院时间（LOS）、重症监护病房（ICU）入院频率和主要并发症发生率。
当术前评估在手术日期前4天或更短时间进行时，住院时间显著缩短（3.91天对4.49天；p = 0.03）。当术前评估在手术日期前11天或更短时间进行时，重症监护病房入院率降低了四倍（p = 0.04）。此外，主要并发症发生率也显著降低（p < 0.05）。然而，当术前评估在手术日期前30天或更短时间进行与在手术日期前超过30天进行相比时，结局没有显著变化。
从本研究来看，更接近手术日期的术前医学评估与选定的围手术期结局改善相关。然而，必须对更大规模的患者群体进行进一步研究以证实这一发现。需要更多研究来确定对感染等罕见事件的影响，并分析THA患者中可能与时间相关且需要进一步时间优化的可改变风险因素的子集。
