Gruskay Jordan, Richardson Shawn, Schairer William, Kahlenberg Cynthia, Steinhaus Michael, Rauck Ryan, Pearle Andrew
Sports Medicine Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America.
Sports Medicine Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America.
Knee. 2019 Jun;26(3):708-713. doi: 10.1016/j.knee.2019.02.002. Epub 2019 Mar 8.
Outpatient surgery is an increasingly attractive option for patients undergoing procedures with established, acceptable risk profiles. Benefits of outpatient surgery include cost savings, enhanced patient experience and improved resource allocation at busy hospitals. The purpose of this study was to compare 90-day complication and readmission rates for patients undergoing unicompartmental knee arthroplasty (UKA) in the outpatient as opposed to the inpatient setting.
Patients who underwent UKA (CPT code 27446) between 2007 and 2016 were retrospectively selected from a national private insurance database. Patients were defined as ambulatory if their coded location of procedure was in an ambulatory surgery center or as an in-hospital outpatient. Postoperative complications were identified using the Reportable Center for Medicare Services (CMS) Complication Measures. Risks of complications were compared between the inpatient and outpatient cohorts using multivariate logistic regression controlling for age, gender, and comorbidities.
2600 patients undergoing ambulatory UKA and 5084 patients undergoing inpatient UKA were identified. The percentage of UKA procedures performed on an outpatient basis significantly increased over the course of the study (14.5% to 58.1%, p < 0.001). After adjusting for age, gender, and comorbidities, ambulatory surgery was found to be associated with a decreased risk of postoperative transfusion (OR 0.28; p < 0.001) and pneumonia (OR 0.23; p = 0.008) and there was a trend towards decreased 90-day readmission risk (OR = 0.83; p = 0.062).
Ambulatory discharge following UKA is increasing in popularity, does not increase risk for perioperative complications or readmission, and may even portend a safer post-operative course.
对于那些手术风险已确定且可接受的患者而言，门诊手术正成为一个越来越有吸引力的选择。门诊手术的益处包括节省费用、提升患者体验以及改善繁忙医院的资源分配。本研究的目的是比较接受单髁膝关节置换术（UKA）的患者在门诊与住院环境下的90天并发症和再入院率。
从一个全国性的私人保险数据库中回顾性选取2007年至2016年间接受UKA（CPT编码27446）的患者。如果患者手术编码位置在门诊手术中心或为医院门诊患者，则被定义为门诊患者。使用医疗保险服务可报告中心（CMS）并发症衡量指标来识别术后并发症。通过多因素逻辑回归控制年龄、性别和合并症，比较住院患者和门诊患者队列的并发症风险。
确定了2600例接受门诊UKA的患者和5084例接受住院UKA的患者。在研究过程中，门诊进行UKA手术的比例显著增加（从14.5%增至58.1%，p<0.001）。在调整年龄、性别和合并症后，发现门诊手术与术后输血风险降低（OR 0.28；p<0.001）和肺炎风险降低（OR 0.23；p = 0.008）相关，并且90天再入院风险有降低趋势（OR = 0.83；p = 0.062）。
UKA术后门诊出院越来越普遍，不会增加围手术期并发症或再入院风险，甚至可能预示着更安全的术后过程。
