Clouette Julien, Agarwalla Avinesh, Ravi Bheeshma, Gandhi Rajiv, Maldonado-Rodriguez Naomi, Saltzman Bryan M, Romeo Anthony A, Leroux Timothy S
Orthopedics. 2020 Jul 1;43(4):204-208. doi: 10.3928/01477447-20200428-03. Epub 2020 May 5.
Administrative database studies have reported on the safety of same-day discharge (SDD) following total joint arthroplasty (TJA); however, most patient cohorts have been defined by length of stay (LOS), and the proportion discharged directly home remains unknown. The purpose of this investigation was to (1) determine common dispositions for patients undergoing SDD TJA; (2) understand changes in discharge disposition over time; and (3) determine the safety of SDD TJA, stratified by discharge disposition. The PearlDiver Database was reviewed for patients who underwent SDD TJA (LOS of 0 days) from 2011 to 2016. Patients were stratified by discharge disposition, and rates and complications following SDD TJA were assessed accordingly. Chi-square analysis was performed to compare demographics and complications between patient groups stratified by disposition. From 2011 to 2016, there was an exponential increase in the annual rate of SDD TJA from 0.95% to 20.5%, respectively; however, the annual proportion of patients discharged directly home remained unchanged (approximately 68%), with the remaining discharged directly to an alternate care facility, most commonly inpatient rehabilitation. Patients discharged to an alternate facility were significantly older (P<.001), had significantly higher comorbidity scores (P<.001), and had significantly more complications (P<.001) than those patients discharged directly home. Although the annual rate of SDD TJA is increasing, up to one-third of patients are not discharged directly home-a proportion unchanged over time. Moving forward, administrative database studies examining SDD TJA must account for discharge disposition; moreover, there is a need to understand the practice of SDD TJA to an alternate care facility. [Orthopedics. 2020;43(4):204-208.].
行政数据库研究报告了全关节置换术（TJA）后当日出院（SDD）的安全性；然而，大多数患者队列是根据住院时间（LOS）定义的，直接回家的患者比例仍然未知。本研究的目的是：（1）确定接受SDD TJA患者的常见出院去向；（2）了解出院去向随时间的变化；（3）按出院去向分层确定SDD TJA的安全性。对PearlDiver数据库中2011年至2016年接受SDD TJA（住院时间为0天）的患者进行了回顾。根据出院去向对患者进行分层，并相应评估SDD TJA后的发生率和并发症。进行卡方分析以比较按出院去向分层的患者组之间的人口统计学和并发症情况。2011年至2016年，SDD TJA的年发生率分别从0.95%呈指数增长至20.5%；然而，直接回家的患者年比例保持不变（约68%），其余患者直接出院至替代护理机构，最常见的是住院康复机构。与直接回家的患者相比，出院至替代机构的患者年龄显著更大（P<0.001），合并症评分显著更高（P<0.001），并发症显著更多（P<0.001）。尽管SDD TJA的年发生率在增加，但高达三分之一的患者并非直接回家——这一比例随时间未变。展望未来，研究SDD TJA的行政数据库研究必须考虑出院去向；此外，有必要了解SDD TJA至替代护理机构的做法。[《骨科》。2020；43（4）：204 - 208。]
