累积活动评分和风险评估及预测工具对预测全膝关节置换术后的出院去向和住院时间是否有用？
Are the Cumulated Ambulation Score and Risk Assessment and Prediction Tool useful for predicting discharge destination and length of stay following total knee arthroplasty?
机构信息
Department of Musculoskeletal Medicine, Vaudois University Hospital Center CHUV, Lausanne, Switzerland.
Department of Musculoskeletal Medicine, Vaudois University Hospital Center CHUV, Lausanne, Switzerland -
出版信息
Eur J Phys Rehabil Med. 2019 Dec;55(6):816-823. doi: 10.23736/S1973-9087.19.05568-0. Epub 2019 Jul 22.
BACKGROUND
Postoperative management of patients undergoing total knee arthroplasty (TKA) is continually changing. Costs related to TKA are driven by implant cost, operating room cost, hospital length of stay (LOS), and rehabilitation approach. Discharges to rehabilitation centers have declined significantly in recent years.
AIM
We evaluated the usefulness of the Cumulated Ambulation Score (CAS) and Risk Assessment and Prediction Tool (RAPT) to predict discharge destination and estimate hospital LOS of patients undergoing TKA.
DESIGN
Prospective cohort study.
SETTING
University hospital inpatients.
POPULATION
Patients undergoing elective primary TKA.
METHODS
Consecutive patients were prospectively evaluated. Outcome measures were discharge destination and LOS dichotomized at the median (LOS<8 versus LOS≥8). Patients completed five outcome questionnaires and knee range of motion was measured preoperatively. RAPT was considered continuous, and also dichotomized (RAPT≤9 versus RAPT>9; RAPT9). CAS was dichotomized (CAS<11 versus CAS≥11; CAS11). Surgical technique and aftercare were similar for all patients.
RESULTS
Sixty-four patients (37 females), mean age 69.3±10.2 years were evaluated. CAS11 and discharge destination were strongly associated: 75.9% of patients with CAS≥11 were discharged home; 85.7% of patients with CAS<11 were discharged to a rehabilitation center (P<0.001). 80.7% of patients with RAPT≤9 were discharged to a rehabilitation center, versus 36.4% of patients with RAPT>9 (P=0.002). Odds ratios for discharge home were 18.9 (CAS11) and 7.3 (RAPT). CAS11 and RAPT were not related to LOS.
CONCLUSIONS
The CAS and RAPT can assist clinicians in estimating the discharge destination and developing patient care plans following TKA. However, predicting LOS with such tools alone was inaccurate.
CLINICAL REHABILITATION IMPACT
Use of the CAS and RAPT can inform discharge destination and patient care plans following TKA and has the potential to optimise resources and costs. However, due to social and organizational constraints on discharge, predicting LOS with such tools alone revealed to be inaccurate.
背景
全膝关节置换术（TKA）患者的术后管理不断变化。与 TKA 相关的成本由植入物成本、手术室成本、医院住院时间（LOS）和康复方法驱动。近年来，康复中心的出院人数显著下降。
目的
我们评估 Cumulated Ambulation Score（CAS）和 Risk Assessment and Prediction Tool（RAPT）在预测 TKA 患者出院去向和估计医院 LOS 方面的有效性。
设计
前瞻性队列研究。
设置
大学医院住院患者。
人群
接受择期初次 TKA 的患者。
方法
连续评估患者。结果测量指标为出院去向和 LOS 二分位数（LOS<8 与 LOS≥8）。患者完成了五项结果问卷，术前测量了膝关节活动度。RAPT 被认为是连续的，也分为二分位数（RAPT≤9 与 RAPT>9；RAPT9）。CAS 分为二分位数（CAS<11 与 CAS≥11；CAS11）。所有患者的手术技术和康复后护理相似。
结果
共评估了 64 名女性患者（37 名），平均年龄 69.3±10.2 岁。CAS11 和出院去向密切相关：CAS≥11 的患者中有 75.9%出院回家；CAS<11 的患者中有 85.7%出院到康复中心（P<0.001）。RAPT≤9 的患者中有 80.7%出院到康复中心，而 RAPT>9 的患者中有 36.4%（P=0.002）。出院回家的优势比为 18.9（CAS11）和 7.3（RAPT）。CAS11 和 RAPT 与 LOS 无关。
结论
CAS 和 RAPT 可帮助临床医生估计 TKA 后的出院去向，并制定患者护理计划。然而，仅使用这些工具预测 LOS 并不准确。
临床康复影响
使用 CAS 和 RAPT 可以为 TKA 后的出院去向和患者护理计划提供信息，并有可能优化资源和成本。然而，由于出院方面的社会和组织限制，仅使用这些工具预测 LOS 并不准确。
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