Feng James E, Anoushiravani Afshin A, Morton Jessica S, Petersen William, Singh Vivek, Schwarzkopf Ran, Macaulay William
Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St., New York, NY, 10003, USA.
Department of Orthopedic Surgery, Beaumont Health Royal Oak, Royal Oak, MI, USA.
Knee Surg Relat Res. 2022 May 8;34(1):26. doi: 10.1186/s43019-022-00152-4.
A better understanding of total knee arthroplasty (TKA) candidate expectations within the perioperative setting will enable clinicians to promote patient-centered practices, optimize recovery times, and enhance quality metrics. In the current study, TKA candidates were surveyed pre- and postoperatively to elucidate the relationship between patient expectations and length of stay (LOS).
This is a prospective study of patients undergoing TKA between December 2017 and August 2018. Patients were electronically administered surveys regarding their discharge plan 10 days pre-/postoperatively. All patients were categorized into three cohorts based on their LOS: 1, 2, and 3+ days. The effect of preoperative discharge education on patient postoperative satisfaction was evaluated.
In total, 221 TKAs were included, of which 83 were discharged on postoperative day (POD) 1, 96 on POD-2, and 42 POD-3+. Female gender, increasing body mass index (BMI), and surgical time correlated with increased LOS. Preoperative discussions regarding LOS occurred in 84.62% (187/221) of patients but did correlate with differences in LOS. However, patients discharged on POD-1 were more inclined to same-day surgery preoperatively. Patients discharged on POD-3+ were found to be more uncomfortable regarding their discharge during the preoperative phase. Multivariable regressions demonstrated that preoperative discharge discussion was positively correlated with home discharge.
Physician-driven discussion regarding patient discharge did not alter patient satisfaction or length of stay but did correlate with improved odds of home discharge. These findings underscore the importance of patient education, shared decision-making, and managing patient expectations.
更好地了解全膝关节置换术（TKA）患者在围手术期的期望，将使临床医生能够推行以患者为中心的医疗实践，优化恢复时间，并提高质量指标。在本研究中，对TKA患者在术前和术后进行了调查，以阐明患者期望与住院时间（LOS）之间的关系。
这是一项对2017年12月至2018年8月期间接受TKA手术患者的前瞻性研究。患者在术前/术后10天通过电子方式接受关于出院计划的调查。所有患者根据住院时间分为三个队列：1天、2天和3天以上。评估术前出院教育对患者术后满意度的影响。
总共纳入了221例TKA手术患者，其中83例在术后第1天出院，96例在术后第2天出院，42例在术后第3天及以上出院。女性、体重指数（BMI）增加和手术时间与住院时间延长相关。84.62%（187/221）的患者进行了术前关于住院时间的讨论，但这与住院时间的差异并无关联。然而，在术后第1天出院的患者术前更倾向于当日手术。发现在术前阶段，在术后第3天及以上出院的患者对出院更感到不适。多变量回归表明，术前出院讨论与回家出院呈正相关。
医生主导的关于患者出院的讨论并未改变患者满意度或住院时间，但与回家出院几率的提高相关。这些发现强调了患者教育、共同决策和管理患者期望的重要性。
