Krieger Dr M, Elias I, Hartmann T
Abteilung Orthopädische Chirurgie, Klinikum GPR Rüsselsheim, Rüsselsheim, Deutschland.
Abteilung Orthopädische Chirurgie, Emma Klinik Seligenstadt, Seligenstadt, Deutschland.
Orthopade. 2020 Apr;49(4):324-333. doi: 10.1007/s00132-020-03888-7.
In 2017, the average length of stay for primary hip replacement patients in Germany was 10.2 days. In our hospital, we have been able to reduce the length of stay in the last 10 years to an average of 3.8 days.
Since September 2015, we offer the 'Hip-in-a-Day' program. This ultra-fast-track pathway consists of a hip arthroplasty procedure with the same day discharge of a well-prepared and explicitly selected patient with maximum intensive interdisciplinary care. The aim is to present the philosophy, treatment principles and daily routine during the pre-, intra- and postoperative phase. The challenges in the German health care system will be discussed.
From September 2015 to November 2019, we operated on 97 patients (50 F: 47 M, ages: 43-77 years, ⌀ 55 years) who had undergone the Hip-in-a-Day pathway. All 97 patients received general anesthesia. Surgery was performed via the direct anterior approach (DAA) to the hip. Patients stayed in the day clinic less than 24 h after surgery. Of these, 30 patients were discharged on the day of surgery (⌀ 12 h stay), and 67 patients left the clinic the day after the operation (⌀ 20 h stay). Due to integrated health-care contracts with health-care providers, we were eligible to receive bundled reimbursement for this patient population.
All 97 patients completed the Ultra-Fast-Track pathway and were able to meet the discharge criteria within 24 h after surgery. 96 of the 97 (98.9%) patients were able to complete Hip-in-a-Day without readmission. One patient had to undergo revision surgery after 10 days due to cup loosening. All patients (100%) were very satisfied with the routine of the day and the fast discharge from the hospital.
The aim of Hip-in-a-Day is to discharge patients within 24 h after surgery. The implementation of the setup at the day clinic is intensive interdisciplinary care of all participating departments, as well as the three cornerstones of anesthesiological management, minimally invasive surgical techniques and patient compliance. In our clinic, ultra-fast-track arthroplasty is routinely feasible and has produced great patient satisfaction. Statutory health-care providers should include short-stay hip arthroplasty into the DRG system, so that this care concept can be reimbursed and practiced nationwide in Germany.
2017年，德国初次髋关节置换患者的平均住院时间为10.2天。在我们医院，过去10年里我们已将住院时间缩短至平均3.8天。
自2015年9月起，我们开展了“一日髋关节置换”项目。这条超快速通道包括对精心准备且经过明确筛选的患者进行髋关节置换手术，并在术后当天让其出院，同时提供最大限度的强化多学科护理。目的是介绍术前、术中和术后阶段的理念、治疗原则及日常流程。还将讨论德国医疗体系中存在的挑战。
2015年9月至2019年11月，我们对97例（50例女性，47例男性，年龄43 - 77岁，平均55岁）接受“一日髋关节置换”流程的患者进行了手术。所有97例患者均接受全身麻醉。手术通过髋关节直接前路（DAA）进行。患者术后在日间诊所停留时间少于24小时。其中，30例患者在手术当天出院（平均停留12小时），67例患者在术后第二天离开诊所（平均停留20小时）。由于与医疗服务提供商签订了综合医疗保健合同，我们有资格获得针对该患者群体的捆绑式报销。
所有97例患者均完成了超快速通道流程，且能够在术后24小时内达到出院标准。97例患者中有96例（98.9%）能够完成一日髋关节置换且无需再次入院。1例患者因髋臼松动在术后10天接受了翻修手术。所有患者（100%）对当天的流程和快速出院非常满意。
一日髋关节置换的目标是在术后24小时内让患者出院。日间诊所的设置实施需要所有参与科室的强化多学科护理，以及麻醉管理、微创手术技术和患者依从性这三个基石。在我们诊所，超快速通道关节置换术常规可行，并获得了患者的高度满意。法定医疗服务提供商应将短期住院髋关节置换纳入疾病诊断相关分组（DRG）系统，以便这种护理理念在德国全国范围内能够得到报销并得以实施。
