Gabor Jonathan A, Singh Vivek, Schwarzkopf Ran, Davidovitch Roy I
NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
Arthroplast Today. 2020 Jun 28;6(3):451-456. doi: 10.1016/j.artd.2020.05.008. eCollection 2020 Sep.
There has been increasing interest in performing primary hip and knee replacement with same-day discharge (SDD). The purpose of this study is to compare patient-reported outcome (PRO) scores, pain scores, and readmissions in patients who underwent SDD total hip arthroplasty (THA) with those in patients who underwent traditional inpatient THA.
A retrospective study was conducted on 963 patients who underwent primary THA at our institution between September 2016 and December 2018. Two cohorts were established based on whether the patient underwent SDD or traditional inpatient THA. An electronic physical engagement application was used to collect PRO scores (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, Veterans Rand 12-Item Health Survey Physical Component Score, and Mental Component Score) and pain scores. To control for demographic variables, a multiple regression analysis of PRO scores was conducted.
Four hundred fifteen (43.1%) patients in this study underwent the SDD protocol. There were significant differences between both cohorts with respect to sex, age, body mass index, American Society of Anesthesiologists score, and smoking status. The bivariate analysis revealed that the SDD cohort had a significantly greater change in the Veterans Rand 12-Item Health Survey Physical Component Score and had fewer readmissions. Both cohorts had equivalent decreases in pain scores. After controlling for demographic variables in a multivariable analysis, the SDD cohort was found to have higher PRO scores at all time points, but there were no significant differences in the change in PRO scores over time between both groups.
Patients in an SDD THA care pathway experienced similar improvements in PRO scores and clinically equal reduction in pain scores.
当日出院（SDD）的初次髋关节和膝关节置换手术越来越受到关注。本研究的目的是比较接受SDD全髋关节置换术（THA）的患者与接受传统住院THA的患者的患者报告结局（PRO）评分、疼痛评分和再入院情况。
对2016年9月至2018年12月在本机构接受初次THA的963例患者进行回顾性研究。根据患者是否接受SDD或传统住院THA建立两个队列。使用电子身体参与应用程序收集PRO评分（关节置换的髋关节残疾和骨关节炎结局评分、退伍军人兰德12项健康调查身体成分评分和精神成分评分）和疼痛评分。为了控制人口统计学变量，对PRO评分进行了多元回归分析。
本研究中有415例（43.1%）患者采用了SDD方案。两个队列在性别、年龄、体重指数、美国麻醉医师协会评分和吸烟状况方面存在显著差异。双变量分析显示，SDD队列在退伍军人兰德12项健康调查身体成分评分上有显著更大的变化，且再入院次数更少。两个队列的疼痛评分下降程度相当。在多变量分析中控制人口统计学变量后，发现SDD队列在所有时间点的PRO评分都更高，但两组之间PRO评分随时间的变化没有显著差异。
接受SDD THA护理路径的患者在PRO评分方面有类似的改善，在临床上疼痛评分的降低程度相当。
