Department of Orthopedic Surgery, Rush University School of Medicine, Chicago, IL.
J Arthroplasty. 2018 Nov;33(11):3402-3406. doi: 10.1016/j.arth.2018.07.025. Epub 2018 Aug 1.
More surgeons are offering patients the option of having adult reconstructive procedures performed as an outpatient at an ambulatory surgery center. However, it is unknown if these patients have higher or lower satisfaction with their care than patients having a traditional inpatient stay. The purpose of this study is to compare satisfaction between inpatients and outpatients undergoing hip or knee arthroplasty.
Portions of the Health Consumer Assessment of Healthcare Providers and Systems survey, the Friends and Family Test, and 8 additional questions were administered to 174 consecutive patients. There were 8 non-responders (95.4% response rate) leaving 102 who underwent inpatient and 64 who had outpatient surgery. Responses were stratified using the "boxes" scoring approach as recommended by Health Consumer Assessment of Healthcare Providers and Systems and analyzed with a chi-squared or Fischer's exact test where appropriate. Power analysis determined that 38 patients per group were needed to detect a 1-point difference in overall satisfaction between groups with 80% power and alpha of 0.05 considered significant.
Outpatients responded with more top responses when asked about the staff's explanation of any medicines received (91.4% vs 77.5%, P = .026), the staff's assistance with their pain management (98.3% vs 88.0%, P = .022), the written health information they were given upon discharge (98.3% vs 90.1%, P = .05), and the courtesy and respect from the nurses (100.0% vs 92.2%, P = .022). Inpatients responded with more bottom responses when asked how prepared they felt for discharge home (8.9% vs 0.0%, P = .014). Top responses in overall satisfaction with the facility (87.1% vs 93.4%, P = .204) and overall experience (89.2% vs 95.2%, P = .177) were similar between inpatients and outpatients, respectively. Not surprisingly, inpatients were older (64.1 vs 59.2 years, P = .001), heavier (body mass index 32.7 vs 30.4, P = .035), and had higher Charlson comorbidity scores (2.6 vs 1.9, P = .002).
Although satisfaction was high in both groups, when differences were present they favored outpatient surgery in the ambulatory surgery center.
越来越多的外科医生为患者提供选择，将成人重建手术作为门诊手术在日间手术中心进行。然而，目前尚不清楚这些患者对护理的满意度是否高于传统住院患者。本研究旨在比较髋关节或膝关节置换术住院患者和门诊患者的满意度。
对 174 例连续患者进行了医疗保健提供者和系统健康消费者评估调查的部分内容、朋友和家人测试以及另外 8 个问题的调查。有 8 名未回复者（95.4%的回复率），其中 102 名接受了住院手术，64 名接受了门诊手术。根据医疗保健提供者和系统健康消费者评估调查推荐的“框”评分方法对回复进行分层，并使用卡方检验或 Fisher 精确检验进行分析（适用时）。功效分析确定每组需要 38 名患者，才能检测到两组之间的整体满意度差异，功效为 80%，α 值为 0.05 被认为具有统计学意义。
当被问及对所接受任何药物的解释（91.4%对 77.5%，P=0.026）、对疼痛管理的帮助（98.3%对 88.0%，P=0.022）、出院时获得的书面健康信息（98.3%对 90.1%，P=0.05）以及护士的礼貌和尊重（100.0%对 92.2%，P=0.022）时，门诊患者的回答更倾向于给出最高评分。当被问及对出院回家的准备程度时（8.9%对 0.0%，P=0.014），住院患者的回答更倾向于给出最低评分。对设施的整体满意度（87.1%对 93.4%，P=0.204）和整体体验（89.2%对 95.2%，P=0.177）的回答在住院患者和门诊患者之间相似。不出所料，住院患者年龄更大（64.1 岁对 59.2 岁，P=0.001）、体重更重（体重指数 32.7 对 30.4，P=0.035）、Charlson 合并症评分更高（2.6 对 1.9，P=0.002）。
尽管两组的满意度都很高，但当存在差异时，门诊手术在日间手术中心更受欢迎。
