Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.
Bone Joint J. 2020 Sep;102-B(9):1167-1175. doi: 10.1302/0301-620X.102B9.BJJ-2020-0247.R1.
The aim of this prospective multicentre study was to describe trends in length of stay and early complications and readmissions following unicompartmental knee arthroplasty (UKA) performed at eight different centres in Denmark using a fast-track protocol and to compare the length of stay between centres with high and low utilization of UKA.
We included data from eight dedicated fast-track centres, all reporting UKAs to the same database, between 2010 and 2018. Complete ( > 99%) data on length of stay, 90-day readmission, and mortality were obtained during the study period. Specific reasons for a length of stay of > two days, length of stay > four days, and 30- and 90-day readmission were recorded. The use of UKA in the different centres was dichotomized into ≥ 20% versus < 20% of arthroplasties which were undertaken being UKAs, and ≥ 52 UKAs versus < 52 UKAs being undertaken annually.
A total of 3,927 procedures were included. Length of stay (mean 1.1 days (SD 1.1), median 1 (IQR 0 to 1)) was unchanged during the study period. The proportion of procedures with a length of stay > two days was also largely unchanged during this time. The percentage of patients discharged on the day of surgery varied greatly between centres (0% to 50% (0 to 481)), with centres with high UKA utilization (both usage and volume) having a larger proportion of same-day discharges. The 30- and 90-day readmissions were 166 (4.2%) and 272 (6.9%), respectively; the 90-day mortality was 0.08% (n = 3).
Our findings suggest general underutilization of the potential for quicker recovery following UKA in a fast-track setup. Cite this article: 2020;102-B(9):1167-1175.
本前瞻性多中心研究的目的是描述在丹麦 8 家不同中心使用快速康复方案行单髁膝关节置换术（UKA）后住院时间和早期并发症及再入院的趋势，并比较 UKA 高使用率和低使用率中心之间的住院时间差异。
我们纳入了 2010 年至 2018 年间在 8 个专门的快速康复中心进行的 UKA 数据，这些中心都向同一个数据库报告 UKA 数据。在研究期间，我们获得了住院时间、90 天再入院和死亡率的完整（>99%）数据。记录了住院时间>2 天、>4 天、30 天和 90 天再入院的具体原因。不同中心 UKA 的使用情况分为接受 UKA 治疗的关节置换术≥20%与<20%，每年行 UKA 手术≥52 例与<52 例，将其分为两组。
共纳入 3927 例手术。住院时间（均值 1.1 天（标准差 1.1），中位数 1（IQR 0 至 1））在研究期间无变化。在此期间，住院时间>2 天的手术比例也基本保持不变。当天出院的患者比例在各中心之间差异很大（0%至 50%（0 至 481）），高 UKA 使用率（使用率和手术量均高）的中心有更大比例的当天出院患者。30 天和 90 天再入院率分别为 166（4.2%）和 272（6.9%），90 天死亡率为 0.08%（n=3）。
我们的研究结果表明，在快速康复方案下，UKA 后快速康复的潜力普遍未得到充分利用。
