Zhang Shaoyun, Huang Qiang, Xie Jinwei, Xu Bin, Cao Guorui, Pei Fuxing
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
J Orthop Surg Res. 2018 Feb 2;13(1):29. doi: 10.1186/s13018-018-0729-x.
Hospital length of stay (LOS) after primary total knee arthroplasty (TKA) has decreased obviously following the implementation of enhanced recovery after surgery (ERAS) program in the last few years. However, there are still some patients that cannot be discharged at early time for a variety of reasons, and it is necessary to explore factors leading to prolonged LOS. Therefore, the purpose of this study was to identify the complete preoperative, perioperative, and postoperative factors associated with prolonged postoperative LOS (PLOS) after primary TKA in a detailed ERAS program.
In a consecutive series from July 2015 to March 2017, all patients who underwent unilateral elective primary TKA were included in the retrospective study. A PLOS greater than 3 days was considered a prolonged PLOS. Multivariable logistic regression analysis was performed to identify patient characteristics and relevant preoperative, perioperative, and postoperative variables that were associated with prolonged PLOS and postoperative complications.
A total of 241 patients were included with a mean PLOS of 3.8 days. Prolonged PLOS was significantly associated with preoperative valgus deformity of the knee (OR 4.95, 95%CI 1.56-15.77, P = 0.007), increased serum level of interleukin-6 on postoperative day 1 (OR 1.01, 95%CI 1.00-1.03, P = 0.039), increased visual analogue scale pain score and serum level of C-reactive protein on postoperative day 3 (OR 2.56, 95%CI 1.28-5.13, P = 0.008; OR 1.01, 95%CI 1.00-1.03, P = 0.019), increased day to achieve 90° active knee flexion after surgery (OR 2.19, 95%CI 1.27-3.79, P = 0.005), and postoperative wound complications (OR 8.58, 95%CI 2.10-35.03, P = 0.003) and other minor complications (OR 6.04, 95%CI 2.40-15.19, P < 0.001). Preoperative pulmonary infection (OR 2.75, 95%CI 1.20-6.28, P = 0.016), American Society of Anesthesiologists score 3/4 (OR 2.14, 95%CI 1.01-4.52, P = 0.046), and utilization of catheter after surgery (OR 2.53, 95%CI 1.23-5.19, P = 0.012) were significantly associated with postoperative complications.
Multiple factors were associated with prolonged PLOS and postoperative complications after TKA in the ERAS program. It is important to recognize all the factors to try to maximize the use of medical resources and ultimately optimize the care of our patients.
在过去几年实施术后加速康复（ERAS）计划后，初次全膝关节置换术（TKA）后的住院时间（LOS）明显缩短。然而，仍有一些患者因各种原因无法早期出院，因此有必要探索导致住院时间延长的因素。因此，本研究的目的是在详细的ERAS计划中确定与初次TKA术后住院时间延长（PLOS）相关的完整术前、围手术期和术后因素。
在2015年7月至2017年3月的连续系列研究中，所有接受单侧择期初次TKA的患者均纳入回顾性研究。PLOS大于3天被认为是住院时间延长。进行多变量逻辑回归分析，以确定与住院时间延长和术后并发症相关的患者特征以及术前、围手术期和术后相关变量。
共纳入241例患者，平均PLOS为3.8天。住院时间延长与术前膝关节外翻畸形（OR 4.95，95%CI 1.56 - 15.77，P = 0.007）、术后第1天血清白细胞介素-6水平升高（OR 1.01，95%CI 1.00 - 1.03，P = 0.039）、术后第3天视觉模拟评分疼痛评分和血清C反应蛋白水平升高（OR 2.56，95%CI 1.28 - 5.13，P = 0.008；OR 1.01，95%CI 1.00 - 1.03，P = 0.019）、术后达到90°主动膝关节屈曲的天数增加（OR 2.19，95%CI 1.27 - 3.79，P = 0.005）以及术后伤口并发症（OR 8.58，95%CI 2.10 - 35.03，P = 0.003）和其他轻微并发症（OR 6.04，95%CI 2.40 - 15.19，P < 0.001）显著相关。术前肺部感染（OR 2.75，95%CI 1.20 - 6.28，P = 0.016）、美国麻醉医师协会评分3/4（OR 2.14，95%CI 1.01 - 4.52，P = 0.046）和术后使用导管（OR 2.53，95%CI 1.23 - 5.19，P = 0.012）与术后并发症显著相关。
在ERAS计划中，多种因素与TKA术后住院时间延长和术后并发症相关。认识所有这些因素对于尽量充分利用医疗资源并最终优化患者护理非常重要。
