Ahmad Mahmood, Shaikh AijazAli, Ahmad Amir Sohaib, Awan Nasir
SHO/ST2, Trauma and Orthopedics, University Hospital Waterford, Ireland.
Registrar, Trauma and Orthopedics, Our Lady of Lourdes Hospital, Drogheda, Ireland.
Surgeon. 2023 Feb;21(1):16-20. doi: 10.1016/j.surge.2022.01.003. Epub 2022 Feb 12.
Total hip and knee arthroplasties are two of the most quality of life enhancing orthopedic procedures performed. Enhanced recovery (ER) programs have been implemented in orthopedic surgery and have helped optimize preoperative, perioperative, and postoperative factors to reduce the physiological and psychological stress of surgery. The American Society of Anesthesiologists [ASA] classification system is now the most widely collected system for measuring physical health status by hip and knee arthroplasty registries worldwide. The aim of the study is to determine whether the ASA score is a predictive of length of hospital stay in patients undergoing hip and knee surgeries in elective setting.
Retrospective data is collected from a consecutive series of 441 charts and Irish National Orthopedics Register (INOR) for patients who underwent elective primary hip & knee replacements from January 1, 2018 to December 31, 2018 in Our Lady's Hospital, Navan. All these patients were assigned either ASA Class 2 or 3 in preoperative assessment.
Total 441 patients were included. Patients with ASA 2 (319 patients of the total patient for the same period), average length of hospital stay was 4.8 ± 1.2 days, whereas for patients with ASA 3 (122 patients of the total), length of hospital stay was 6.5 ± 2.3 with mean difference between two groups was 1.7 days (95% confidence interval of this difference).
Patients with ASA 2 stayed shorter in the hospital compared to patients with ASA 3. Therefore, we recommend that pre-operative patients' optimization to downgrade a patient from an ASA 3 to ASA 2, but prospective analysis would be beneficial to examine the resource implications of such an initiative as well as patient outcomes with longer term follow up.
全髋关节置换术和全膝关节置换术是两种最能提高生活质量的骨科手术。强化康复（ER）计划已在骨科手术中实施，有助于优化术前、围手术期和术后因素，以减轻手术的生理和心理压力。美国麻醉医师协会（ASA）分类系统是目前全球髋关节和膝关节置换术登记处用于衡量身体健康状况的最广泛收集的系统。本研究的目的是确定ASA评分是否可预测择期行髋关节和膝关节手术患者的住院时间。
回顾性收集了2018年1月1日至2018年12月31日在纳凡圣母医院接受择期初次髋关节和膝关节置换术患者的441份连续病历及爱尔兰国家骨科登记处（INOR）的数据。所有这些患者在术前评估中被分为ASA 2级或3级。
共纳入441例患者。ASA 2级患者（同期总患者中的319例），平均住院时间为4.8±1.2天，而ASA 3级患者（总患者中的122例），住院时间为6.5±2.3天，两组间平均差异为1.7天（该差异的95%置信区间）。
与ASA 3级患者相比，ASA 2级患者住院时间更短。因此，我们建议对术前患者进行优化，将患者从ASA 3级降至ASA 2级，但前瞻性分析将有助于研究该举措对资源的影响以及长期随访的患者预后。
