Department of Orthopedic Surgery, NYU Langone Health, The New York Hip Institute, 485 Madison Ave. 8th Floor, New York, USA.
Arch Orthop Trauma Surg. 2022 May;142(5):861-869. doi: 10.1007/s00402-021-03983-0. Epub 2021 Jun 1.
As more centers introduce same-day discharge (SDD) total joint arthroplasty (TJA) programs, it is vital to understand the factors associated with successful outpatient TJA and whether outcomes vary for those that failed SDD. The purpose of this study is to compare outcomes of patients that are successfully discharged home the day of surgery to those that fail-to-launch (FTL) and require a longer in-hospital stay.
We retrospectively reviewed all patients who enrolled in our institution's SDD TJA program from 2015 to 2020. Patients were stratified into two cohorts based on whether they were successfully SDD or FTL. Outcomes of interest included discharge disposition, 90-day readmissions, 90-day revisions, surgical time, and patient-reported outcome measures (PROMs) as assessed by the FJS-12 (3 months, 1 year, and 2 years), HOOS, JR, and KOOS, JR (preoperatively, 3 months, and 1 year). Demographic differences were assessed with chi-square and Mann-Whitney U tests. Outcomes were compared using multilinear regressions, controlling for demographic differences.
A total of 1491 patients were included. Of these, 1384 (93%) were successfully SDD while 107 (7%) FTL and required a longer length-of-stay. Patients who FTL were more likely to be non-married (p = 0.007) and ASA class III (p = 0.017) compared to those who were successfully SDD. Surgical time was significantly longer for those who FTL compared to those who were successfully SDD (100.86 vs. 83.42 min; p < 0.001). Discharge disposition (p = 0.100), 90-day readmissions (p = 0.897), 90-day revisions (p = 0.997), and all PROM scores both preoperatively and postoperatively did not significantly differ between the two cohorts.
Our results support the notion that FTL is not a predictor of adverse outcomes as patients who FTL achieved similar outcomes as those who were successfully SDD. The findings of this study can aid orthopedic surgeons to educate their patients who wish to participate in a similar program, as well as patients that have concerns after they failed to go home on the day of surgery.
Retrospective Cohort Study.
随着越来越多的中心引入当日出院（SDD）全关节置换术（TJA）计划，了解与门诊 TJA 成功相关的因素以及 SDD 失败的患者的结局是否存在差异至关重要。本研究的目的是比较成功出院回家的患者与未能成功出院（FTL）并需要更长住院时间的患者的结局。
我们回顾性分析了 2015 年至 2020 年期间参加我们机构 SDD TJA 计划的所有患者。根据患者是否成功 SDD 或 FTL，将其分为两组。感兴趣的结局包括出院去向、90 天再入院、90 天翻修、手术时间以及由 FJS-12（3 个月、1 年和 2 年）、HOOS、JR 和 KOOS，JR（术前、3 个月和 1 年）评估的患者报告结局测量（PROMs）。采用卡方检验和曼-惠特尼 U 检验评估人口统计学差异。使用多元线性回归比较结局，控制人口统计学差异。
共纳入 1491 例患者。其中，1384 例（93%）成功 SDD，107 例（7%）FTL 并需要更长的住院时间。FTL 患者与成功 SDD 患者相比，更有可能未婚（p=0.007）和 ASA 分级 III（p=0.017）。与成功 SDD 患者相比，FTL 患者的手术时间明显更长（100.86 比 83.42 分钟；p<0.001）。两组之间在出院去向（p=0.100）、90 天再入院（p=0.897）、90 天翻修（p=0.997）以及所有术前和术后 PROM 评分均无显著差异。
我们的结果支持 FTL 不是不良结局的预测因素的观点，因为 FTL 患者的结局与成功 SDD 患者相似。本研究的结果可以帮助骨科医生教育希望参加类似计划的患者，以及对手术日未能出院的患者提供相关信息。
回顾性队列研究。
