Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
PLoS One. 2021 Dec 7;16(12):e0260816. doi: 10.1371/journal.pone.0260816. eCollection 2021.
Programs referred to as Fast-Track/Rapid Recovery/Enhanced Recovery After Surgery have proven both effective and safe in joint replacement surgery, to the degree where same-day discharge (SDD) has been attempted in carefully selected cases at specialized outpatient units. Therefore, the primary aim of this study was to evaluate a same-day surgery protocol regarding safety using the minor partial knee replacement (PKR) procedure by non-selectively recruiting patients at a public hospital for one consecutive year.
33 unselected PKR cases were included in this open clinical trial. The inclusion/exclusion criteria were solely based on logistics, as all the procedures were medial PKRs, designated the first morning slots, and performed by one single-surgeon. Strict postoperative criteria based on vital parameters, urinary function, bleeding, and mobilization had to be met before discharge was considered. SDD rate, patient satisfaction, number of outpatient visits, adverse events and readmissions within 90 days were evaluated. A predetermined subgroup analysis was also conducted where patients <80 yrs. and with an American Society of Anesthesiologists (ASA) classification <III was compared with those aged ≥80 yrs. and/or ASA class ≥III.
29 of 33 (88%) successfully achieved SDD. In a univariate comparison, 100% of the patients <80 yrs. and ASA class <III achieved SDD, whereas a corresponding 43% applied for those aged ≥80 yrs. and/or ASA class ≥III (p = 0.001). A 93% overall satisfaction rate was reached. Only 8% extra outpatient visits were required, all occurring within the first 2 weeks (well in line with routine practice.) One plausible transient ischemic attack and one readmission caused by a penetrating trauma not affecting the knee were identified, both of which happened 10 weeks after surgery. No adverse events or readmissions occurred within the first 48 hours of surgery.
When following strict criteria for discharge, same-day partial knee replacement surgery may be both feasible and safe, even without preselection of patients.
在关节置换手术中，快速通道/快速康复/手术后强化康复方案已被证明是有效且安全的，以至于在专门的门诊单位中，已经在精心挑选的病例中尝试了当天出院（SDD）。因此，本研究的主要目的是通过非选择性地在公立医院招募患者进行为期一年的连续研究，使用微创膝关节置换术（PKR）来评估一种关于安全性的当天手术方案。
本开放性临床试验共纳入 33 例非选择性 PKR 病例。纳入/排除标准仅基于物流，因为所有手术均为内侧 PKR，指定为第一个上午的手术时段，并由一位单名外科医生进行。只有在满足生命体征、尿功能、出血和活动能力等严格的术后标准后，才考虑出院。评估 SDD 率、患者满意度、门诊就诊次数、90 天内的不良事件和再入院率。还进行了预定的亚组分析，将年龄<80 岁且美国麻醉医师协会（ASA）分级<III 与年龄≥80 岁和/或 ASA 分级≥III 的患者进行比较。
33 例患者中有 29 例（88%）成功实现 SDD。在单变量比较中，年龄<80 岁且 ASA 分级<III 的患者 100%实现 SDD，而年龄≥80 岁和/或 ASA 分级≥III 的患者相应的 SDD 为 43%（p=0.001）。总体满意度达到 93%。仅需要额外的 8%门诊就诊，均发生在术后前 2 周（与常规做法相符）。发现一例可能的短暂性脑缺血发作和一例因穿透性创伤导致的膝关节以外的再入院，均发生在术后 10 周。在手术的前 48 小时内，没有发生任何不良事件或再入院。
在严格的出院标准下，即使不对患者进行预筛选，当天进行膝关节部分置换手术也可能是可行且安全的。
