Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK.
University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK.
Ann R Coll Surg Engl. 2021 May;103(5):324-331. doi: 10.1308/rcsann.2020.7142. Epub 2021 Mar 19.
A high volume of total hip, total knee and unicompartmental knee arthroplasty procedures, an ageing population and continuing financial pressures within the English NHS mean that strategies to reduce length of hospital stay are attractive. Enhanced recovery after surgery protocols are one such intervention, and have advanced so that daycase arthroplasty is now possible. This study examines the current rate of daycase arthroplasty within the English NHS.
Hospital episode statistics data from all English NHS providers of arthroplasty procedures were analysed. Activity, daycase rate, length of stay and readmission rates were recorded. All total hip, knee and unicompartmental knee operations undertaken within the time period 1 July 2018 to 30 June 2019 were examined.
Length of stay was analysed for 162,966 patients; 74,665 (46%) were total hip arthroplasty, 79,252 (49%) were total knee arthroplasty and 9,049 were unicompartmental knee arthroplasty (5%). Mean length of stay was 4.08 days for total hip, 4.11 days for total knee and 2.64 days for unicompartmental knee arthroplasties. Daycase rate for total hip arthroplasty was 0.55%, 0.52% for total knee arthroplasty and 5.44% for unicompartmental knee arthroplasty. The percentage of patients staying in hospital for longer than four days (a length of stay of five days or more) was 18.61% of total hip arthroplasty spells, 20.54% of total knee arthroplasty spells and 5.48% of unicompartmental knee arthroplasty spells.
This large observational study of unselected patients undergoing hip and knee arthroplasty demonstrates that the national daycase rate for arthroplasty across providers in the NHS is low. Mean length of stay remains higher than selected international comparators.
全髋关节、全膝关节和单髁膝关节置换术数量大、人口老龄化以及英国国民保健制度（NHS）持续面临财政压力，这些因素都促使人们寻求降低住院时间的策略。术后强化康复方案是一种干预手段，已经取得了进展，现在可以进行日间手术。本研究调查了英国国民保健制度下目前日间手术的比例。
对所有提供关节置换术的英国国民保健制度提供者的医院住院统计数据进行了分析。记录了活动量、日间手术比例、住院时间和再入院率。检查了 2018 年 7 月 1 日至 2019 年 6 月 30 日期间进行的所有全髋关节、膝关节和单髁膝关节手术。
对 162966 名患者的住院时间进行了分析；其中 74665 例（46%）为全髋关节置换术，79252 例（49%）为全膝关节置换术，9049 例为单髁膝关节置换术（5%）。全髋关节置换术的平均住院时间为 4.08 天，全膝关节置换术为 4.11 天，单髁膝关节置换术为 2.64 天。全髋关节置换术的日间手术比例为 0.55%，全膝关节置换术为 0.52%，单髁膝关节置换术为 5.44%。住院时间超过四天（住院五天或以上）的患者比例为全髋关节置换术 18.61%，全膝关节置换术 20.54%，单髁膝关节置换术 5.48%。
这项针对接受髋关节和膝关节置换术的未选择患者的大型观察性研究表明，英国国民保健制度中提供者的关节置换术全国日间手术比例较低。平均住院时间仍高于选定的国际可比指标。
