双侧直接前入路全髋关节置换术的医院不良事件和围手术期结果。
Hospital Adverse Events and Perioperative Outcomes in Bilateral Direct Anterior Approach Total Hip Arthroplasty.
机构信息
Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL.
Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Miami, FL.
出版信息
J Arthroplasty. 2020 Mar;35(3):762-766. doi: 10.1016/j.arth.2019.10.005. Epub 2019 Oct 9.
BACKGROUND
Perioperative hospital adverse events represent a significant outcome that is often overlooked. Even "minor events" such as fever or tachycardia may lead to significant costs due to workup tests, interconsultations, and/or increased length of stay (LOS). The optimal timing of bilateral direct anterior approach total hip arthroplasty (DAA-THA) remains unsettled. Consequently, we wanted to compare hospital LOS, discharge disposition, hospital adverse events (major and minor), and transfusion rates between simultaneous and staged bilateral DAA-THA.
METHODS
A retrospective chart review was conducted on a consecutive series of 347 primary bilateral DAA-THAs (204 patients) performed by 2 surgeons in a single institution (2010-2016). The hips finally included were categorized as simultaneous (Sim-n = 61), staged 1 (Stg1-n = 143), or staged 2 (Stg2-n = 143). We also compared simultaneous with staged surgeries performed ≤1 and >1 year apart. Baseline demographics, LOS, discharge disposition, hospital adverse events, and transfusions were assessed.
RESULTS
The simultaneous group had significantly younger patients and a higher proportion of males when compared with the staged groups and showed significant longer LOS [2.61 (Sim) vs 2.06 (Stg1) vs 1.63 (Stg2) days, P < .001], lower proportion of home discharge [77% (Sim) vs 91.6% (Stg1) vs 96.5% (Stg2), P < .001], as well as higher (overall) rate of adverse events [31.1% (Sim) vs 28.7% (Stg1) vs 14.0% (Stg2), P = .003] and transfusions [45.9% (Sim) vs 6.3% (Stg1) vs 7.0% (Stg2), P < .001]. However, most transfusions were autologous [37.7% (Sim) vs 3.5% (Stg1) vs 0% (Stg2), P < .001].
CONCLUSION
Our data show that bilateral DAA-THAs performed in a staged fashion, rather than simultaneously, have a shorter hospital LOS and decreased rates of adverse events and overall transfusions. Notwithstanding, simultaneous surgery should still be considered an option in selected patients.
LEVEL OF EVIDENCE
Level III.
背景
围手术期医院不良事件是一个重要的结局，但往往被忽视。即使是“小事件”，如发热或心动过速，也可能由于检查、会诊和/或住院时间延长而导致显著的费用。双侧直接前方入路全髋关节置换术（DAA-THA）的最佳时机仍未确定。因此，我们比较了同期双侧和分期双侧 DAA-THA 之间的住院时间、出院处置、医院不良事件（主要和次要）和输血率。
方法
对 2 名医生在一家机构连续进行的 347 例双侧初次 DAA-THA（204 例患者）进行回顾性图表分析（2010-2016 年）。最终纳入的髋关节分为同期（Sim-n=61）、分期 1（Stg1-n=143）和分期 2（Stg2-n=143）。我们还比较了同期与≤1 年和>1 年的分期手术。评估了基线人口统计学、住院时间、出院处置、医院不良事件和输血。
结果
同期组患者年龄明显小于分期组，男性比例也明显高于分期组，且住院时间明显延长[2.61 天（Sim）vs 2.06 天（Stg1）vs 1.63 天（Stg2），P<.001]，出院回家的比例较低[77%（Sim）vs 91.6%（Stg1）vs 96.5%（Stg2），P<.001]，以及更高的（总体）不良事件发生率[31.1%（Sim）vs 28.7%（Stg1）vs 14.0%（Stg2），P=0.003]和输血率[45.9%（Sim）vs 6.3%（Stg1）vs 7.0%（Stg2），P<.001]。然而，大多数输血是自体的[37.7%（Sim）vs 3.5%（Stg1）vs 0%（Stg2），P<.001]。
结论
我们的数据表明，分期进行双侧 DAA-THA 比同期进行的手术具有更短的住院时间，且不良事件和总输血率较低。尽管如此，同期手术仍应作为某些患者的选择。
证据水平
3 级。
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