非创伤性原发性全髋关节置换术的快速通道方案可缩短住院时间：前瞻性法国多中心研究。

Fast track protocol for primary total hip arthroplasty in non-trauma cases reduces the length of hospital stay: Prospective French multicenter study.

机构信息

Clinique de l'Union, boulevard Ratalens, 31240 St Jean, France.

Centre hospitalier universitaire Amiens-Picardie, 80054 Amiens cedex 1, France.

出版信息

Orthop Traumatol Surg Res. 2020 Dec;106(8):1527-1531. doi: 10.1016/j.otsr.2020.05.017. Epub 2020 Oct 24.

DOI:10.1016/j.otsr.2020.05.017

PMID:33109491

Abstract

BACKGROUND

Fast-track (FT) procedures continue to evolve; however, their benefits are still controversial. This led us to conduct a prospective study of FT procedures for total hip arthroplasty (THA) on a national scale in France with historical control data. The aims were to (1) evaluate the effectiveness of FT procedures after THA on the length of hospital stay (LOS) in a multicenter analysis, (2) measure the immediate return to home, rehospitalization and reoperation rates.

HYPOTHESIS

FT procedures reduce the LOS after primary THA for non-traumatic indications relative to national historical data.

METHODS

A prospective observational study was done at 11 hospital facilities throughout France. Patients who underwent primary THA for a non-traumatic condition and FT procedures were followed for 3 months. The average LOS, discharge to home, unexpected readmissions, and reoperation rate were compared to 2016 figures from the French national database of 104,745 procedures on the same population.

RESULTS

The study included 1,110 patients, 499 men (45%) and 611 women (55%), with a mean age of 67.5±11.9 years. The average LOS was 3.3±2.9 days versus 7.5±5.3 days in the national database (p<0.001). Eight hundred eighty patients (79%) were discharged directly to home versus 72,577 (69%) in the national database (p<0.001). Forty-two patients (4%) were readmitted to the hospital within 90 days of the THA versus 11,092 (11%) in the national database (p<0.001). Eighteen patients (1.6%) were reoperated within 90 days of the THA procedure versus 2100 (2.0%) in the national database (p=0.72).

DISCUSSION

FT procedures help to significantly reduce the average LOS and rehospitalization rate after primary THA for non-traumatic conditions and significantly increased the percentage of patients being discharged directly to home relative to national historical data, without altering the risk of reoperation. FT procedures should become the standard of care after THA.

LEVEL OF EVIDENCE

III; prospective case-control study.

摘要

背景

快速通道（FT）程序仍在不断发展；然而，其益处仍存在争议。这促使我们在法国进行了一项针对全髋关节置换术（THA）的 FT 程序的全国范围的前瞻性研究，并结合历史对照数据。目的是：（1）在多中心分析中评估 THA 后 FT 程序对住院时间（LOS）的有效性；（2）测量即刻返回家中、再入院和再手术的比率。

假设

与国家历史数据相比，FT 程序可减少非创伤性指征的初次 THA 后的 LOS。

方法

在法国的 11 家医院进行了一项前瞻性观察性研究。对因非创伤性疾病而行初次 THA 且接受 FT 程序的患者进行了 3 个月的随访。将平均 LOS、出院回家、意外再入院和再手术率与 2016 年法国 104745 例相同人群的全国数据库数据进行比较。

结果

该研究纳入了 1110 例患者，其中 499 例男性（45%）和 611 例女性（55%），平均年龄为 67.5±11.9 岁。平均 LOS 为 3.3±2.9 天，而全国数据库为 7.5±5.3 天（p<0.001）。880 例（79%）患者直接出院回家，而全国数据库为 72577 例（69%）（p<0.001）。42 例（4%）患者在 THA 后 90 天内再次入院，而全国数据库为 11092 例（11%）（p<0.001）。18 例（1.6%）患者在 THA 后 90 天内再次手术，而全国数据库为 2100 例（2.0%）（p=0.72）。