Research Fellow, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
Associate Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
J Foot Ankle Surg. 2020 Jul-Aug;59(4):694-697. doi: 10.1053/j.jfas.2019.09.034. Epub 2020 Apr 11.
Despite an increasing trend in the number of total ankle arthroplasties (TAAs) being done globally, current evidence remains limited with regards to factors influencing a non-home discharge to a facility following the procedure. The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 27702 for patients undergoing TAA. Discharge to a destination was categorized into home and non-home. Multivariate analysis using logistic regression models were used to evaluate independent risk factors associated with non-home discharge disposition. As a secondary objective, we also evaluated risk factors associated with a prolonged length of stay (LOS) >2 days. A total of 722 TAAs were retrieved for final analysis. A total of 68 (9.4%) patients experienced a non-home discharge following the surgery. Independent factors for a non-home discharge were a LOS >2 days (odds ratio [OR] 10.51), age ≥65 years (OR 4.52), female (OR 2.90), hypertension (OR 2.63), and American Society of Anesthesiologists >II (OR 2.01). A total of 174 (24.1%) patients stayed in the hospital for more than 2 days. Significant risk factors for LOS >2 days were age ≥65 years (OR 1.62), female (OR 1.53), operative time >150 minutes (OR 1.91), and an inpatient admission status (OR 4.74). With limited literature revolving around outcomes following TAA, the current study identifies significant predictors associated with a non-home discharge. Providers should consider preoperatively risk-stratifying and expediting discharge in these patients to reduce the costs associated with a prolonged hospital length of stay.
尽管全球范围内进行的全踝关节置换术（TAA）数量呈上升趋势，但目前关于影响术后非家庭出院到医疗机构的因素的证据仍然有限。使用 2012-2016 年美国外科医师学会-国家手术质量改进计划数据库，通过 Current Procedural Terminology 代码 27702 对接受 TAA 的患者进行查询。出院目的地分为家庭和非家庭。使用逻辑回归模型进行多变量分析，以评估与非家庭出院处置相关的独立危险因素。作为次要目标，我们还评估了与延长住院时间（LOS）>2 天相关的危险因素。共检索到 722 例 TAA 进行最终分析。共有 68 例（9.4%）患者在手术后出现非家庭出院。非家庭出院的独立因素包括 LOS>2 天（优势比[OR]10.51）、年龄≥65 岁（OR 4.52）、女性（OR 2.90）、高血压（OR 2.63）和美国麻醉医师协会>II（OR 2.01）。共有 174 例（24.1%）患者住院时间超过 2 天。 LOS>2 天的显著危险因素是年龄≥65 岁（OR 1.62）、女性（OR 1.53）、手术时间>150 分钟（OR 1.91）和住院入院状态（OR 4.74）。由于关于 TAA 后结局的文献有限，目前的研究确定了与非家庭出院相关的重要预测因素。提供者应考虑在这些患者术前进行风险分层并加快出院，以降低与延长住院时间相关的成本。
