Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2021 Jul;36(7S):S258-S263.e1. doi: 10.1016/j.arth.2020.10.011. Epub 2020 Oct 15.
A higher volume of primary total hip arthroplasty (THA) is starting to be performed as an outpatient procedure. However, data on appropriate patient selection for this surgical protocol is scarce.
Patients who underwent primary THA were identified in the 2012-2018 National Surgical Quality Improvement Program database. Outpatient procedure was defined as having a hospital length of stay of 0 days. The primary outcome was a readmission within the 30-day postoperative period. Risk factors for and effect of overnight hospital stay on 30-day readmission after outpatient THA were identified through multivariable models. Reasons for and timing of readmission were also identified.
A total of 5245 outpatient THA patients and 44,171 patients who stayed 1 night were identified. The incidence of 30-day readmission after outpatient THA was 1.60% (95% confidence interval [CI] 1.26-1.94). Risk factors for 30-day readmission after outpatient THA include the following: older age relative to 18-60 years old (most notably 71-75 years old, relative risk [RR] = 2.3, 95% CI = 1.15-4.62; 76-80 years old, RR = 6.6, 95% CI = 3.55-12.43; and >80 years old, RR = 5.6, 95% CI = 2.43-12.89, P < .001) and bleeding disorders (RR = 4.5, 95% CI = 1.45-14.31, P = .010). For patients who had some of these risk factors, their risk of medically related 30-day readmission was reduced if they had stayed 1 night at the hospital (P < .05). The majority of readmissions were surgically related (62%), including wound complications (27%) and periprosthetic fractures (25%).
The rate of 30-day readmission after outpatient THA was low. Patients who are at high risk for 30-day readmission after outpatient THA include those with older age and bleeding disorders. Some of these patients may benefit from an inpatient hospital stay.
越来越多的初次全髋关节置换术（THA）开始作为门诊手术进行。然而，关于该手术方案的合适患者选择的数据仍然缺乏。
在 2012 年至 2018 年国家手术质量改进计划数据库中确定初次 THA 患者。门诊手术定义为住院时间为 0 天。主要结果是术后 30 天内再入院。通过多变量模型确定门诊 THA 后过夜住院与 30 天再入院的风险因素及其影响。还确定了再入院的原因和时间。
共确定了 5245 例门诊 THA 患者和 44171 例住院 1 晚的患者。门诊 THA 后 30 天内再入院的发生率为 1.60%（95%置信区间 [CI] 1.26-1.94）。门诊 THA 后 30 天内再入院的风险因素包括以下因素：与 18-60 岁相比年龄较大（尤其是 71-75 岁，相对风险 [RR] 2.3，95%CI 1.15-4.62；76-80 岁，RR 6.6，95%CI 3.55-12.43；>80 岁，RR 5.6，95%CI 2.43-12.89，P <.001）和出血性疾病（RR 4.5，95%CI 1.45-14.31，P =.010）。对于具有这些风险因素的患者，如果在医院住院 1 晚，其与医疗相关的 30 天内再入院风险降低（P <.05）。大多数再入院与手术相关（62%），包括伤口并发症（27%）和假体周围骨折（25%）。
门诊 THA 后 30 天内再入院率较低。门诊 THA 后 30 天内再入院风险较高的患者包括年龄较大和出血性疾病的患者。其中一些患者可能受益于住院治疗。
