A Formal Same-Day Discharge Total Joint Arthroplasty Program May Not Be Necessary: A Propensity-Matched Cohort Study. 正式的当日出院全关节置换计划可能并非必要：一项倾向匹配队列研究。
A Formal Same-Day Discharge Total Joint Arthroplasty Program May Not Be Necessary: A Propensity-Matched Cohort Study.
机构信息
Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
出版信息
J Arthroplasty. 2022 Aug;37(8S):S823-S829. doi: 10.1016/j.arth.2022.02.081. Epub 2022 Feb 25.
BACKGROUND
Same-day discharge (SDD) total joint arthroplasty (TJA) programs often have stringent selection criteria. Some patients deemed ineligible may nonetheless be discharged on the day of surgery. This study compares the outcomes between patients enrolled in our SDD TJA program who were SDD to those who did not participate in the program but were also SDD.
METHODS
We retrospectively reviewed all patients who were SDD following TJA from 2015 to 2020. Patients were stratified into two cohorts based on whether they were formally enrolled in our institution's SDD TJA program. Propensity-score matching was performed to limit confounding and independent sample t-tests or Pearson's chi-squared tests were used to compare outcomes of interest between the matched groups.
RESULTS
Of the 1778 patients included, 1384 (78%) completed the SDD TJA program and 394 (22%) were SDD but did not participate in the SDD TJA program. Upon 1:1 propensity-score matching, a total of 550 patients were matched for comparison. The surgical time was significantly longer for patients who did not participate in the SDD TJA program compared to those who participated in the program (109.39 vs 87.29 minutes; P < .001). Discharge disposition (P = .999), 90-day emergency department visits (P = .476), 90-day all-cause readmissions (P = .999), 90-day all-cause revisions (P = .563), and Hip disability and Osteoarthritis Outcome Scores for Joint Replacement (HOOS, JR) and Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement at all time points did not significantly differ.
CONCLUSION
Enrollment in a formal SDD TJA program may not be a necessary precursor to achieving similar outcomes following TJA for patients who are SDD without formally enrolling. Therefore, a formal program may no longer be needed at an institution with well-established evidence-based protocols with strong success and an experience with value-based care.
LEVEL III EVIDENCE
Retrospective Cohort Study.
背景
当日出院（SDD）全关节置换术（TJA）计划通常有严格的选择标准。一些不符合条件的患者仍可能在手术当天出院。本研究比较了我们 SDD TJA 计划中符合 SDD 条件的患者与不符合 SDD 条件但也符合 SDD 的患者的结局。
方法
我们回顾性分析了 2015 年至 2020 年所有接受 TJA 后 SDD 的患者。根据患者是否正式参加我们机构的 SDD TJA 计划，将患者分为两组。采用倾向评分匹配法来限制混杂因素，并采用独立样本 t 检验或 Pearson 卡方检验比较匹配组之间的结局。
结果
在 1778 例患者中，1384 例（78%）完成了 SDD TJA 计划，394 例（22%）符合 SDD 条件但未参加 SDD TJA 计划。经过 1:1 倾向评分匹配，共有 550 例患者进行了匹配比较。未参加 SDD TJA 计划的患者手术时间明显长于参加 SDD TJA 计划的患者（109.39 分钟比 87.29 分钟；P<0.001）。出院去向（P=0.999）、90 天内急诊就诊（P=0.476）、90 天内全因再入院（P=0.999）、90 天内全因翻修（P=0.563）、髋关节残疾和骨关节炎关节置换评分（HOOS，JR）和膝关节损伤和骨关节炎关节置换评分在所有时间点均无显著差异。
结论
对于不符合正式 SDD TJA 计划但符合 SDD 条件的患者，参加正式的 SDD TJA 计划可能不是实现 TJA 后类似结局的必要前提。因此，在具有成熟的基于证据的协议、强大的成功经验和基于价值的护理经验的机构中，可能不再需要正式计划。
等级 III 证据：回顾性队列研究。
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