Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, P. R. China.
Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, P. R. China.
Orthop Surg. 2022 Sep;14(9):1989-1997. doi: 10.1111/os.13382. Epub 2022 Jul 20.
To investigate the safety, efficiency and cost of total joint arthroplasty (TJA) under the enhanced recovery after surgery (ERAS) program and identify predictors facilitating further decrease in length of stay (LOS).
We retrospectively collected the information of patients who underwent primary unilateral TJA by a single surgical team between January 2017 and June 2019. A total of 604 patients with LOS ≤ 3 was enrolled in this study. All patients completed 12-month or longer follow-up. Patients received the same ERAS protocol, mainly including preoperative preparation (patient education, preoperative functional exercises, nutritional support), blood management, pain management, sleep management, prevention of infection, prevention of thrombosis and strict discharge criteria. Preoperative characteristics of patients were collected from the medical record system and were compared between the LOS ≤ 2 group and the LOS = 3 group. Factors with significant difference were included in multivariate logistic regression analysis to find independent preoperative predictors for LOS. Joint function at the latest follow-up, adverse events rate and hospitalization costs were compared between the LOS ≤ 2 group and the LOS = 3 group.
Of the enrolled 604 patients, 271 patients (44.9%) had a LOS of 2 days or less while 333 patients (55.1%) had a LOS of 3 days. Pittsburgh Sleep Quality Index score (odds ratio [OR] = 1.084, 95% confidence interval [CI] = 1.024-1.147, P = 0.005), preoperative albumin level (OR = 0.945, 95% CI = 0.905-0.988, P = 0.012), digestive diseases (OR = 1.084, 95% CI = 1.024-1.147, P = 0.005) and total hip arthroplasty (THA) (OR = 0.273, 95% CI = 0.170-0.439, P < 0.001) were predictors of LOS ≤ 2 in the multivariate logistic analysis model. The postoperative joint function scores and adverse event rates were comparable between the LOS ≤ 2 group and the LOS = 3 group. The hospital costs were lower in the LOS ≤ 2 group than the LOS = 3 group.
Under the rigorous ERAS program, 2-day discharge in unselected TJA patients can be routinely applied. Patients with high preoperative sleep quality, high preoperative albumin level, free of digestive disease and undergoing THA procedure are more likely to be discharged within 2 days.
探讨加速康复外科（ERAS）方案下全关节置换术（TJA）的安全性、有效性和成本，并确定有助于进一步缩短住院时间（LOS）的预测因素。
我们回顾性收集了 2017 年 1 月至 2019 年 6 月期间由单一手术团队进行的单侧初次 TJA 患者的信息。本研究共纳入 LOS≤3 的 604 例患者。所有患者均完成了 12 个月或更长时间的随访。患者接受相同的 ERAS 方案，主要包括术前准备（患者教育、术前功能锻炼、营养支持）、血液管理、疼痛管理、睡眠管理、预防感染、预防血栓形成和严格的出院标准。从病历系统中收集患者的术前特征，并将 LOS≤2 组和 LOS=3 组进行比较。将有显著差异的因素纳入多变量逻辑回归分析，以寻找 LOS 的独立术前预测因素。比较 LOS≤2 组和 LOS=3 组的末次随访时关节功能、不良事件发生率和住院费用。
在纳入的 604 例患者中，271 例（44.9%）的 LOS 为 2 天或更短，333 例（55.1%）的 LOS 为 3 天。匹兹堡睡眠质量指数评分（比值比[OR] = 1.084，95%置信区间[CI] = 1.024-1.147，P=0.005）、术前白蛋白水平（OR = 0.945，95%CI = 0.905-0.988，P=0.012）、消化系统疾病（OR = 1.084，95%CI = 1.024-1.147，P=0.005）和全髋关节置换术（THA）（OR = 0.273，95%CI = 0.170-0.439，P<0.001）是多变量逻辑分析模型中 LOS≤2 的预测因素。LOS≤2 组和 LOS=3 组的术后关节功能评分和不良事件发生率相当。LOS≤2 组的住院费用低于 LOS=3 组。
在严格的 ERAS 方案下，未选择的 TJA 患者可以常规进行 2 天出院。术前睡眠质量高、白蛋白水平高、无消化系统疾病和接受 THA 手术的患者更有可能在 2 天内出院。
