From the Rancho Los Amigos National Rehabilitation Center, Department of Surgery-Surgical Arthritis, Downey, CA (Dr. Kay, Dr. Taylor, Dr. Tye, Dr. Bryman, and Dr. Runner), and the Department of Orthopaedic Surgery, Medical Center, Harbor-University of California, Los Angeles, CA (Dr. Kay, Dr. Taylor, Dr. Tye, and Dr. Bryman).
J Am Acad Orthop Surg Glob Res Rev. 2021 Sep 16;5(9):e21.00117. doi: 10.5435/JAAOSGlobal-D-21-00117.
High-percentage outpatient total joint arthroplasty (TJA) performed in a safety net hospital system has not been described. A rapid recovery protocol (RRP) was instituted at our safety net hospital that allowed eventual transition to outpatient TJA.
Retrospective review of all primary total knee and hip arthroplasty performed by a single surgeon (RR) using an RRP was performed. The initial cohort of patients was monitored overnight with the goal of next-day discharge (n = 57), and as the RRP evolved, the subsequent cohort of patients had the possibility of same-day discharge (PSDD, n = 61). Outcome measures included the rate of same-day discharge in the PSDD cohort and short-term adverse event rates.
In the PSDD cohort, 86.9% (n = 53) of patients were successfully discharged on the day of surgery, and hospital length of stay was decreased by 17.7 hours (13.5 versus 31.2 hours, P < 0.0001). Comparing the next-day discharge and PSDD groups, no significant differences were found in 30-day emergency department visits (5.3% versus 3.3%, P = 0.67), 90-day complications (15.8% versus 13.1%, P = 0.79), 90-day readmissions (0% versus 3.3%, P = 0.50), or 90-day revision surgeries (0% versus 3.3%, P = 0.50).
This study demonstrates that the transition to outpatient TJA can be successfully performed in a safety net hospital system without increasing short-term adverse events.
在 医疗保险 医院系统中进行高比例的门诊全关节置换术（TJA）尚未得到描述。我们的医疗保险医院实施了快速康复方案（RRP），最终实现了门诊 TJA 的过渡。
对一名外科医生（RR）使用 RRP 进行的所有初次全膝关节和髋关节置换术进行回顾性研究。最初的患者队列在医院过夜监测，目标是次日出院（n = 57），随着 RRP 的发展，随后的患者队列有可能当天出院（PSDD，n = 61）。结果测量包括 PSDD 队列中当天出院的比率和短期不良事件发生率。
在 PSDD 队列中，86.9%（n = 53）的患者成功在手术当天出院，住院时间缩短了 17.7 小时（13.5 小时与 31.2 小时，P < 0.0001）。比较次日出院和 PSDD 组，30 天内急诊就诊率（5.3%比 3.3%，P = 0.67）、90 天内并发症发生率（15.8%比 13.1%，P = 0.79）、90 天内再入院率（0%比 3.3%，P = 0.50）或 90 天内翻修手术率（0%比 3.3%，P = 0.50）均无显著差异。
本研究表明，在医疗保险医院系统中成功过渡到门诊 TJA 不会增加短期不良事件。
