Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR.
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC.
J Arthroplasty. 2021 Jul;36(7S):S168-S172. doi: 10.1016/j.arth.2021.01.015. Epub 2021 Jan 11.
Identifying predictors of failed same-day discharge (SDD) is critical for patient selection. We evaluated patient factors associated with failure of SDD in patients undergoing elective total joint arthroplasty (TJA) in a hospital setting.
We retrospectively reviewed consecutive patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) between January 31, 2018 and February 1, 2020 by one of the 3 fellowship-trained arthroplasty surgeons. Patient demographics, comorbidities, and clinical data were collected. Analysis was performed to assess risk factors for failed SDD.
In total, 2615 TJAs (1425 TKAs, 1190 THAs) were performed over the study period. Two hundred seventy-one (10.4%) were SDDs (80 TKAs, 191 THAs). There were fewer TKAs than THAs (5.6% vs 16.1%, P < .001). Forty-five patients failed SDD (16.6%). Failure rates were similar in TKA and THA (18.8%, 15.7%, P = .54). The most common reasons for failure of SDD were hypotension (11, 24.4%), delayed resolution of spinal anesthesia (11, 24.4%), and nausea (5, 11.1%). Age over 70 years (P = .007), greater than 2 self-reported allergies (P < .001), and preoperative narcotic use (P = .01) were associated with failure of SDD. Gender, body mass index, American Society of Anesthesiologists class, and prior TJA were not significantly associated (P > .05).
Success of SDD was greater than 80%. Hypotension, delayed resolution of spinal anesthesia, and nausea accounted for 60% of failures of SDD. Patients >70 years, those with >2 self-reported drug allergies, or patients who used preoperative narcotics were at high risk for failure of SDD after THA or TKA.
确定当日出院（SDD）失败的预测因素对于患者选择至关重要。我们评估了在医院环境中接受择期全关节置换术（TJA）的患者中与 SDD 失败相关的患者因素。
我们回顾性分析了 2018 年 1 月 31 日至 2020 年 2 月 1 日期间由 3 名 fellowship培训的关节置换外科医生之一进行的初次全膝关节置换术（TKA）和全髋关节置换术（THA）的连续患者。收集患者人口统计学、合并症和临床数据。进行分析以评估 SDD 失败的危险因素。
在研究期间，共进行了 2615 例 TJA（1425 例 TKA，1190 例 THA）。271 例（10.4%）为 SDD（80 例 TKA，191 例 THA）。TKA 少于 THA（5.6%比 16.1%，P<.001）。45 例患者 SDD 失败（16.6%）。TKA 和 THA 的 SDD 失败率相似（18.8%，15.7%，P=0.54）。SDD 失败的最常见原因是低血压（11 例，24.4%），脊髓麻醉后延迟缓解（11 例，24.4%）和恶心（5 例，11.1%）。年龄>70 岁（P=.007），>2 种自我报告的过敏（P<.001）和术前使用麻醉剂（P=0.01）与 SDD 失败相关。性别，体重指数，美国麻醉师协会分级和先前的 TJA 与 SDD 失败无显著相关性（P>.05）。
SDD 的成功率>80%。低血压，脊髓麻醉后延迟缓解和恶心占 SDD 失败的 60%。THA 或 TKA 后，年龄>70 岁，有>2 种自我报告药物过敏或术前使用麻醉剂的患者，SDD 失败的风险较高。
