Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Bone Joint J. 2021 Jul;103-B(7 Supple B):84-90. doi: 10.1302/0301-620X.103B7.BJJ-2020-2341.R1.
The proportion of arthroplasties performed in the ambulatory setting has increased considerably. However, there are concerns whether same-day discharge may increase the risk of complications. The aim of this study was to compare 90-day outcomes between inpatient arthroplasties and outpatient arthroplasties performed at an ambulatory surgery centre (ASC), and determine whether there is a learning curve associated with performing athroplasties in an ASC.
Among a single-surgeon cohort of 970 patients who underwent arthroplasty at an ASC, 854 (88.0%) were matched one-to-one with inpatients based on age, sex, American Society of Anesthesiologists (ASA) grade, BMI, and procedure (105 could not be adequately matched and 11 lacked 90-day follow-up). The cohort included 281 total hip arthroplasties (THAs) (32.9%), 267 unicompartmental knee arthroplasties (31.3%), 242 primary total knee arthroplasties (TKAs) (28.3%), 60 hip resurfacings (7.0%), two revision THAs (0.3%), and two revision TKAs (0.3%). Outcomes included readmissions, reoperations, visits to the emergency department, unplanned clinic visits, and complications.
The inpatient and outpatient groups were similar in all demographic variables, reflecting successful matching. The reoperation rate was 0.9% in both cohorts (p = 1.000). Rates of readmission (2.0% inpatient vs 1.6% outpatient), any complications (5.9% vs 5.6%), minor complications (4.2% vs 3.9%), visits to the emergency department (2.7% vs 1.4%), and unplanned clinic visits (5.7% vs 5.5%) were lower in the outpatient group but did not reach significance with the sample size studied. A learning curve may exist, as seen by significant reductions in the reoperation and overall complication rates among outpatient arthroplasties over time (p = 0.032 and p = 0.007, respectively), despite those in this group becoming significantly older and heavier (both p < 0.001) during the study period.
Arthroplasties performed at ASCs appear to be safe in appropriately selected patients, but may be associated with a learning curve as shown by the significant decrease in complication and reoperation rates during the study period. Cite this article: 2021;103-B(7 Supple B):84-90.
在门诊环境中进行的关节置换术比例显著增加。然而，人们担心当日出院是否会增加并发症的风险。本研究的目的是比较在门诊手术中心（ASC）进行的住院和门诊关节置换术的 90 天结局，并确定在 ASC 进行关节置换术是否存在学习曲线。
在一位外科医生的单组 970 例 ASC 关节置换术患者中，根据年龄、性别、美国麻醉医师协会（ASA）分级、BMI 和手术类型（105 例无法充分匹配，11 例缺乏 90 天随访），854 例患者与住院患者进行一对一匹配。该队列包括 281 例全髋关节置换术（THA）（32.9%）、267 例单髁膝关节置换术（UKA）（31.3%）、242 例初次全膝关节置换术（TKA）（28.3%）、60 例髋关节表面置换术（7.0%）、2 例翻修 THA（0.3%）和 2 例翻修 TKA（0.3%）。结局包括再入院、再次手术、急诊就诊、非计划门诊就诊和并发症。
住院组和门诊组在所有人口统计学变量上均相似，反映了成功匹配。两组的再手术率均为 0.9%（p=1.000）。再入院率（住院组 2.0%，门诊组 1.6%）、任何并发症发生率（5.9% vs. 5.6%）、轻微并发症发生率（4.2% vs. 3.9%）、急诊就诊率（2.7% vs. 1.4%）和非计划门诊就诊率（5.7% vs. 5.5%）在门诊组较低，但由于研究样本量，这些差异无统计学意义。随着时间的推移，门诊关节置换术的再手术和总体并发症发生率呈显著下降趋势，可能存在学习曲线（p=0.032 和 p=0.007），尽管在此期间该组患者的年龄和体重显著增加（均 p<0.001）。
在适当选择的患者中，ASC 进行的关节置换术似乎是安全的，但可能存在学习曲线，因为在研究期间，并发症和再手术率显著下降。
参考文献：2021;103-B(7 Supple B):84-90.
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