Medical Resident, Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Orthopedic Research Director, Indiana University Health Hip & Knee Center, Saxony Hospital, Fishers, Indiana.
J Arthroplasty. 2022 Dec;37(12):2387-2393. doi: 10.1016/j.arth.2022.06.022. Epub 2022 Jul 4.
Operative time is related to complications in primary total hip arthroplasty (THA). This study compared operative time in direct anterior (DA) and posterior approach THA and whether differences were related to increased hospital readmissions within 90 days of discharge.
Prospectively documented data on 3,152 consecutively performed THAs by 16 surgeons at a large Midwestern United States academic healthcare system were retrospectively reviewed. All surgeons were beyond their learning curve. Cases characterized by factors extending operative time were excluded. A total of 1,235 analysis cases were performed with the DA approach and 1,608 with the posterior approach. DA patients had lower mean body mass index (P < .001), were more likely to be classified as American Society of Anesthesiologists Physical Status 1 or 2 (P < .001), and more likely to have surgery in an ambulatory setting (P < .001).
Time under anesthesia was significantly longer for DA procedures by 19 to 27 minutes in hospital and ambulatory settings, respectively (P < .001). Increasing body mass index had a greater impact on anesthesia time for DA patients (P = .020). There were no differences in nontraumatic readmissions within 90 days of surgery based on surgical approach (P ≥ .480); however, significantly more DA patients classified as ASA-PS 3 or 4 were readmitted compared to those classified as ASA-PS 1 or 2 (P < .001), a difference not observed for posterior approach patients.
Anesthesia time is a modifiable risk factor for patient safety and an important factor in healthcare resource utilization. Consideration of ways to reduce DA operative times is encouraged.
手术时间与初次全髋关节置换术（THA）的并发症有关。本研究比较了直接前入路（DA）和后入路 THA 的手术时间，以及这些差异是否与出院后 90 天内的住院再入院率增加有关。
回顾性分析了一家位于美国中西部的大型学术医疗系统的 16 位外科医生连续完成的 3152 例 THA 的前瞻性记录数据。所有外科医生均已过学习曲线。排除了手术时间延长的因素。共对 1235 例采用 DA 入路的病例和 1608 例采用后入路的病例进行了分析。DA 患者的平均体重指数（BMI）较低（P <.001），更可能被归类为美国麻醉医师协会身体状况 1 级或 2 级（P <.001），更可能在门诊环境下进行手术（P <.001）。
DA 手术的麻醉时间在住院和门诊环境下分别延长了 19 至 27 分钟（P <.001）。BMI 增加对 DA 患者的麻醉时间影响更大（P =.020）。根据手术方式，术后 90 天内非创伤性再入院率无差异（P ≥.480）；然而，与 ASA-PS 1 或 2 级患者相比，更多的 DA 患者被归类为 ASA-PS 3 或 4 级被再入院（P <.001），而后入路患者则没有观察到这种差异。
麻醉时间是患者安全的一个可改变的风险因素，也是医疗资源利用的一个重要因素。鼓励考虑减少 DA 手术时间的方法。
