Yakkanti Ramakanth R, Miller Adam J, Smith Langan S, Feher Anthony W, Mont Michael A, Malkani Arthur L
School of Medicine, University of Louisville, Louisville, KY, USA.
KentuckyOne Health Medical Group, 201 Abraham Flexner Way, Louisville, KY, USA.
Ann Transl Med. 2019 Feb;7(4):69. doi: 10.21037/atm.2019.02.02.
Decreasing length of stay (LOS) following primary total knee arthroplasty (TKA) has been an important focus by all the stakeholders involved in the delivery of care. LOS is dictated by both the patient and hospital-related factors. The purpose of this study was to determine if early mobilization on post-operative day 0 (POD 0) following primary TKA has an effect on hospital LOS and discharge to home rehabilitation facilities.
An analysis was performed of consecutive primary TKAs performed at a single institution over one year. Patients were assigned to two groups: POD 0 or POD 1, based on their day of mobilization. Patients were mobilized following surgery based on time of arrival to the orthopaedic floor and availability of physical therapy (PT) resources. The two groups were compared for LOS and discharge disposition using univariate analysis. A total of 408 consecutive TKAs were evaluated and from this group, a total of 143 patients who were mobilized on POD 0 were then matched to 143 patients mobilized on POD 1. There were no significant differences in age, sex, American Society of Anesthesiologists score, or body mass index (BMI) between POD 0 and POD 1 groups.
There was a significant difference in LOS between POD 0 and POD 1 groups, 2.44 2.80 days (P=0.002). There were also differences in discharge to home rehabilitation, 70.63% of the POD 0 cohort were discharged home compared to 58.74% in POD 1 (P=0.035).
There was a significant reduction in LOS and there were differences in discharge disposition between patients who mobilized on POD 0 POD 1, with more patients mobilized on POD 0 discharged home. Hospitals should work with their total joint arthroplasty programs to mobilize close to 100% of the patients undergoing primary TKA on POD 0 in order to decrease LOS and healthcare expenditure.
缩短初次全膝关节置换术（TKA）后的住院时间（LOS）一直是参与医疗服务的所有利益相关者关注的重点。住院时间受患者和医院相关因素的影响。本研究的目的是确定初次TKA术后第0天（POD 0）早期活动是否会影响住院时间和出院至家庭康复机构的情况。
对在单一机构进行的连续一年的初次TKA病例进行分析。根据患者活动的日期，将患者分为两组：POD 0组或POD 1组。患者术后根据到达骨科病房的时间和物理治疗（PT）资源的可用性进行活动。使用单因素分析比较两组的住院时间和出院处置情况。共评估了408例连续的TKA病例，其中143例在POD 0进行活动的患者与143例在POD 1进行活动的患者进行匹配。POD 0组和POD 1组在年龄、性别、美国麻醉医师协会评分或体重指数（BMI）方面无显著差异。
POD 0组和POD 1组的住院时间存在显著差异，分别为2.44±2.80天（P=0.002）。出院至家庭康复的情况也存在差异，POD 0队列中有70.63%的患者出院回家，而POD 1组为58.74%（P=0.035）。
POD 0进行活动的患者住院时间显著缩短，出院处置情况存在差异，POD 0进行活动的患者出院回家的更多。医院应与全关节置换项目合作，使接近100%接受初次TKA的患者在POD 0进行活动，以减少住院时间和医疗费用。
