Nakasone Cass K, Combs Dylan, Buchner Brian, Andrews Samantha
Straub Medical Center, Bone and Joint Center, Honolulu, HI 96813, United States of America; University of Hawai'i, Department of Surgery, Honolulu, HI 96813, United States of America.
John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, United States of America.
Knee. 2020 Jun;27(3):1043-1048. doi: 10.1016/j.knee.2020.03.003. Epub 2020 Apr 15.
Unilateral unicompartmental knee arthroplasty (UKA) is considered an outpatient procedure, however, previous research has reported a wide success rate range for day of surgery (DOS) discharge. Previous rapid discharge protocols (RDPs) have focused on pain management and nausea control but are commonly done in outpatient facilities, limiting the generalizability to the community hospital setting. Therefore, this study compared the rate of successful DOS discharge after the implementation of a RDP compared to the previous standard discharge protocol (SDP) following unilateral UKA.
A retrospective chart review was completed for 174 unselected consecutive patients having undergone unilateral UKA between January 2016 and May 2018. The RDP was implemented in March 2017, with the addition of an arthroplasty dedicated hospitalist, a change to patient discharge expectations and a change to post-operative patient navigation. All other surgical and patient care procedures were identical for both groups.
Evaluation included 89 patients in the SDP group and 90 patients in the RDP group. Successful DOS discharge rate increased significantly from 11.2% for the SDP group to 72.2% for the RDP group (p = 0.000). Two patients from each group were treated with antibiotics for stitch abscess and no patient sustained a major complication within 90 days.
Small, significant changes applied in the current study resulted in a significant increase in success of DOS discharge. These procedures can be easily implemented in all settings and may be more representative of the discharge capabilities for non-selected patients seen in the community hospital setting.
单侧单髁膝关节置换术（UKA）被认为是一种门诊手术，然而，先前的研究报道了手术当天（DOS）出院的成功率范围很广。先前的快速出院方案（RDPs）主要集中在疼痛管理和恶心控制方面，但通常在门诊设施中进行，限制了其在社区医院环境中的普遍适用性。因此，本研究比较了在单侧UKA后实施RDP与先前标准出院方案（SDP）后DOS成功出院的比率。
对2016年1月至2018年5月期间连续接受单侧UKA的174例未经选择的患者进行回顾性病历审查。RDP于2017年3月实施，增加了一名关节置换专科住院医师，改变了患者出院预期，并改变了术后患者指导。两组的所有其他手术和患者护理程序均相同。
评估包括SDP组的89例患者和RDP组的90例患者。SDP组的DOS成功出院率从11.2%显著提高到RDP组的72.2%（p = 0.000）。每组有两名患者因缝线脓肿接受抗生素治疗，90天内无患者发生重大并发症。
本研究中应用的微小但显著的改变导致DOS出院成功率显著提高。这些程序可以在所有环境中轻松实施，并且可能更能代表社区医院环境中未经选择患者的出院能力。
