From the Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN (Mascioli, Dabov, Toy), the Campbell Foundation, Germantown, TN (Shaw, Wilder, Bell), and the Pacira BioSciences, Inc., Parsippany, NJ (Boykin, Mahadevan).
J Am Acad Orthop Surg. 2021 Dec 1;29(23):e1184-e1192. doi: 10.5435/JAAOS-D-20-00934.
Migration of total knee arthroplasty (TKA) procedures from the inpatient setting to outpatient venues, especially freestanding ambulatory surgery centers (ASCs), requires the use of reliable patient selection algorithms and standardized perioperative pathways to facilitate favorable outcomes for patients.
This retrospective chart review included consecutive TKA procedures performed over a 5-year period between January 2014 and January 2019 at 2 freestanding ASCs. The patient selection algorithm was developed on the basis of patient comorbidities to minimize the potential for adverse events. All procedures were performed by one of eight orthopedic surgeons who were identified a priori as adhering to similar multimodal pain management regimens, including the use of spinal anesthesia, general or monitored-care anesthesia, adductor canal blocks, pericapsular injection of liposomal bupivacaine, nonsteroidal anti-inflammatory drugs, gabapentin, tramadol, acetaminophen, and oxycodone on an as-needed basis. Outcomes, including surgical complications, healthcare resource utilization (HCRU), and patient satisfaction, were measured before discharge and at a 90-day follow-up visit.
Four hundred thirty-nine TKA procedures in 386 patients were identified for inclusion. Of these patients, 115 (29.8%) were performed in patients with the American Society of Anesthesiologists physical status IIIa. Mean (standard deviation) length of stay at the ASC was 500 (107) minutes, including 136 (47) minutes of surgery and 201 (78) minutes to ambulation. The overall rates of surgical complications and 90-day hospital admissions were low (1.4% and 0.7%, respectively), as was the need for additional HCRU, including additional surgical procedures related to index surgery, emergency department visits, and unplanned clinic visits or calls. At the 90-day follow-up visit, 96% of patients reported being pleased with their outcomes.
With careful patient selection, standardized perioperative pathways, and multimodal analgesia protocols, TKA procedures can be performed in the ASC setting with low complication rates, minimal postdischarge HCRU, and high rates of patient satisfaction.
III.
全膝关节置换术（TKA）从住院环境向门诊场所（尤其是独立的日间手术中心 [ASC]）转移，需要使用可靠的患者选择算法和标准化的围手术期路径，以促进患者的良好结局。
本回顾性图表研究包括 2014 年 1 月至 2019 年 1 月在 2 个独立 ASC 进行的连续 TKA 手术。患者选择算法是基于患者合并症制定的，以最大限度地降低不良事件的发生风险。所有手术均由 8 名骨科医生中的一位进行，这些医生预先确定采用类似的多模式疼痛管理方案，包括使用脊髓麻醉、全身或监测下护理麻醉、收肌管阻滞、囊周注射脂质体布比卡因、非甾体抗炎药、加巴喷丁、曲马多、对乙酰氨基酚和奥施康定按需使用。在出院时和 90 天随访时测量手术并发症、医疗保健资源利用（HCRU）和患者满意度等结局。
共纳入 386 例患者的 439 例 TKA 手术。这些患者中，115 例（29.8%）为美国麻醉医师协会身体状况 IIIa 级患者。ASC 的平均（标准差）住院时间为 500（107）分钟，包括手术时间 136（47）分钟和步行时间 201（78）分钟。手术并发症和 90 天内住院率均较低（分别为 1.4%和 0.7%），需要额外的 HCRU 也较低，包括与索引手术相关的其他手术、急诊就诊、计划外就诊或电话咨询。在 90 天随访时，96%的患者报告对他们的结局感到满意。
通过精心选择患者、标准化围手术期路径和多模式镇痛方案，TKA 手术可在 ASC 环境下进行，具有较低的并发症发生率、最低限度的出院后 HCRU 和较高的患者满意度。
III 级。
