Area Anestesiologia, Rianimazione, Terapie Intensive e Terapia del Dolore, Fondazione Policlinico A. Gemelli, Rome, Italy.
Istituto di Anestesia e Rianimazione, Fondazione Policlinico A. Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy.
Musculoskelet Surg. 2020 Apr;104(1):87-92. doi: 10.1007/s12306-019-00603-4. Epub 2019 May 3.
Enhanced recovery after surgery (ERAS) protocols aim to develop peri-operative multidisciplinary programs to shorten length of hospital stay (LOS) and reduce complications, readmissions and costs for patients undergoing major surgery. The aim of this study is to evaluate the effects of an ERAS pathway for total hip (THR) and knee (TKR) replacement surgery in terms of length of stay, incidence of complications and patient satisfaction.
Patients scheduled for hip and knee replacement were included in the study. The main aspects of this program were preoperative education/physical therapy, rational choice of the anesthetic technique, optimization of multimodal analgesia, reduction of incidence of urinary retention and catheterization, active management of risk for blood loss and deep vein thrombosis, and early mobilization of the patients. All patients had 6 months predicted and planned follow-up appointments. Primary outcomes of the study were the mean LOS, readmission and complication rates. Secondary Outcomes were percentage of Knee Injury & Osteoarthritis Outcome Score (KOOS) and Hip disability and Osteoarthritis Outcome Score (HOOS) increase and patient's satisfaction.
We consecutively enrolled 207 patients who underwent total joint arthroplasty, 78 hip and 129 knee joint replacements. The mean length of stay (LOS) for patients of the two groups was 4.3 days for ASA 3-4 patients subjected to TKR and THR, in ASA 1-2 patients 3.6 days for TKR and 3.9 days for THR respectively. Postoperative satisfaction level was higher than 7 (very satisfied) in 94.4% of the cases. All patients were discharged home: 61.8% continued physical therapy in complete autonomy, 23.7% supported by a home-physiotherapist and only 14.5% needed the attendance to a physiotherapy center on a daily basis. The overall incidence of major complications was 3.4%.
The implementation of an ERAS program for hip and knee replacement surgery allows early patient's discharge and a quick return to independency in the daily activities.
IV.
术后加速康复（ERAS）方案旨在制定围手术期多学科方案，以缩短住院时间（LOS）并降低接受大手术的患者的并发症、再入院率和成本。本研究旨在评估全髋关节（THR）和膝关节（TKR）置换手术中 ERAS 路径在住院时间、并发症发生率和患者满意度方面的效果。
纳入计划接受髋关节和膝关节置换的患者。该方案的主要方面包括术前教育/物理治疗、合理选择麻醉技术、优化多模式镇痛、降低尿潴留和导尿发生率、积极管理出血和深静脉血栓形成风险，以及患者的早期活动。所有患者均有 6 个月的预测和计划随访预约。本研究的主要结果是平均 LOS、再入院率和并发症发生率。次要结果是膝关节损伤和骨关节炎评分（KOOS）和髋关节残疾和骨关节炎评分（HOOS）增加的百分比以及患者的满意度。
我们连续纳入了 207 例接受全关节置换术的患者，其中 78 例髋关节置换术和 129 例膝关节置换术。ASA 3-4 级接受 TKR 和 THR 的患者平均住院时间（LOS）为 4.3 天，ASA 1-2 级患者 TKR 为 3.6 天，THR 为 3.9 天。术后满意度水平高于 7（非常满意）的患者占 94.4%。所有患者均出院回家：61.8%继续完全自主进行物理治疗，23.7%由家庭物理治疗师支持，只有 14.5%需要每天到物理治疗中心就诊。主要并发症的总发生率为 3.4%。
髋关节和膝关节置换手术中 ERAS 方案的实施允许患者早期出院，并快速恢复日常生活的独立性。
IV。
Zotero 插件