全髋关节和膝关节置换患者快速康复计划逐步实施的结果。
The results of a stepwise implementation of a fast-track program in total hip and knee replacement patients.
作者信息
Drosos Georgios I, Kougioumtzis Ioannis E, Tottas Stylianos, Ververidis Athanasios, Chatzipapas Christos, Tripsianis Grigorios, Tilkeridis Konstantinos
机构信息
Chairman of Academic Department of Orthopaedic Surgery, Faculty of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece.
University General Hospital of Alexandroupolis, Alexandroupolis, PO Box 68100, Greece.
出版信息
J Orthop. 2020 Mar 25;21:100-108. doi: 10.1016/j.jor.2020.03.004. eCollection 2020 Sep-Oct.
BACKGROUND
Several reports have shown that enhanced recovery or fast-track (FT) regime introduction in patients undergoing total knee replacement (TKR) and total hip replacement (THR) results in significant reduction in length of stay (LOS) with no associated increase of complications or readmission rate. Despite that, FT programs for arthroplasty have has not been uniformly recognized or accepted by many orthopaedic surgeons and there is still no consensus on the best implementation process. The aim of this study was to report the results of a stepwise implementation of a FT regime in TKR and THR patients in a general orthopaedic department.
MATERIAL AND METHODS
This was a retrospective study of prospectively collected data (from 2014 to 2017) concerning all consecutive unselected patients who underwent TKR or THR on Monday morning. At stage 1 the rehabilitation and physiotherapy component was changed, at stage 2 and 3 a patient's blood management program and a pain management program were prospectively recorded (i.e. respectively Patients' demographics, ASA classification, Charlson index, LOS, blood loss, transfusion rate, complications and 30 - day readmissions).
RESULTS
Four hundred and thirty four patients underwent either TKR (n: 302) or THR (n:132) and were included in this study. A gradual reduction of mean LOS was found in THR patients from 5.7 days to 3.0 days and in TKR patients from 5.6 days to 3.4 days. Furthermore, no significant difference was found in complications or regarding the 30-day readmission rate at the different stages of implementation of the different FT components (i.e. at the final stage 96.7% of THR and 86.7% of TKR patients were discharged to home by the fourth post-operative day).
CONCLUSION
The stepwise implementation of a FT program in an unelected population of THR and TKR patients was effective and safe, reducing the post-surgical recovery time and patients' LOS with no major complications and no increase of 30-day re-admissions.
背景
多项报告显示，在接受全膝关节置换术（TKR）和全髋关节置换术（THR）的患者中引入强化康复或快速康复（FT）方案，可显著缩短住院时间（LOS），且不会增加并发症或再入院率。尽管如此，关节置换术的FT方案尚未得到许多骨科医生的一致认可或接受，对于最佳实施过程也仍未达成共识。本研究的目的是报告在普通骨科科室对TKR和THR患者逐步实施FT方案的结果。
材料与方法
这是一项对前瞻性收集的数据（2014年至2017年）进行的回顾性研究，数据涉及所有在周一上午接受TKR或THR的连续未筛选患者。在第1阶段，康复和物理治疗部分发生了变化，在第2和第3阶段，前瞻性记录了患者的血液管理方案和疼痛管理方案（即分别记录患者的人口统计学资料、美国麻醉医师协会（ASA）分级、查尔森指数、住院时间、失血量、输血率、并发症和30天再入院情况）。
结果
434例患者接受了TKR（n = 302）或THR（n = 132），并纳入本研究。发现THR患者的平均住院时间从5.7天逐渐减少至3.0天，TKR患者从5.6天减少至3.4天。此外，在不同FT组件实施的不同阶段，并发症或30天再入院率方面未发现显著差异（即在最后阶段，96.7%的THR患者和86.7%的TKR患者在术后第四天出院回家）。
结论
在未筛选的THR和TKR患者群体中逐步实施FT方案是有效且安全的，可缩短术后恢复时间和患者的住院时间，且无重大并发症，30天再入院率也未增加。
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