单髁膝关节置换术后 88%的患者实现当日出院的成功经验：系统评价和荟萃分析。
Successful same-day discharge in 88% of patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis.
机构信息
Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):946-962. doi: 10.1007/s00167-022-07094-0. Epub 2022 Aug 11.
PURPOSE
The purpose of this study was to evaluate the effectiveness of day-case unicompartmental knee arthroplasty (UKA) by assessment of successful same-day discharge (SDD), readmission, complication and reoperation rates in the recent literature.
METHODS
For this systematic review and meta-analysis, PubMed, Embase and Cochrane Library were comprehensively searched to identify all eligible studies reporting outcomes of day-case UKA. Studies with intended same-day home discharge after UKA were included. A meta-analysis of proportions, using a random-effects model, was performed to estimate overall rates of successful SDD and adverse events. Subgroup analyses were performed for studies including selected patients (i.e., patients had to meet certain patient-specific criteria to be eligible for day-case UKA) and unselected patients (i.e., no additional criteria for day-case UKA), as well as for clinical and registry-based studies. Additional outcomes included reasons for the failure of SDD and patient satisfaction.
RESULTS
A total of 29 studies and 9694 patients were included with a mean age of 66 ± 9 years and mean follow-up of 59 days (mean range 30-270 days). Based on 24 studies (2733 patients), the overall successful SDD rate was 88% (95% confidence interval [CI] 80-92). These rates were 91% (95% CI 84-95) across studies with selected patients and 76% (95% CI 55-89) across studies with unselected patients. Overall readmission, complication and reoperation rates were 3% (95% CI 1.9-4.4), 4% (95% CI 2.8-5.2) and 1% (95% CI 0.8-1.3), respectively. Inability to mobilize, nausea and uncontrolled pain were frequently reported reasons for failed SDD. The overall patient satisfaction rate was 94%.
CONCLUSION
This systematic review with meta-analysis found an overall successful SDD rate of 88% after UKA in a heterogeneous cohort of selected and unselected patients. Readmission, complication and reoperation rates suggest UKA can be performed safely and effectively as a same-day discharge procedure.
LEVEL OF EVIDENCE
Level IV, systematic review of level III and IV studies.
目的
本研究旨在评估单髁膝关节置换术（UKA）日间手术的效果，通过评估近期文献中成功的当日出院（SDD）、再入院、并发症和再次手术率来评价。
方法
本系统评价和荟萃分析检索了 PubMed、Embase 和 Cochrane 图书馆，以确定所有报告 UKA 日间手术结果的合格研究。纳入 UKA 后有意愿当日出院回家的研究。采用随机效应模型对比例进行荟萃分析，以估计 SDD 和不良事件的总发生率。对包括特定患者（即，患者必须符合某些特定的患者标准才有资格接受日间 UKA）和未选择患者（即，日间 UKA 无其他标准）的研究以及临床和基于注册的研究进行了亚组分析。其他结局包括 SDD 失败的原因和患者满意度。
结果
共纳入 29 项研究和 9694 例患者，平均年龄 66±9 岁，平均随访时间为 59 天（平均范围 30-270 天）。基于 24 项研究（2733 例患者），SDD 总成功率为 88%（95%可信区间 80-92）。在包括特定患者的研究中，这一比例为 91%（95%可信区间 84-95），在包括未选择患者的研究中，这一比例为 76%（95%可信区间 55-89）。总体再入院率、并发症发生率和再次手术率分别为 3%（95%可信区间 1.9-4.4）、4%（95%可信区间 2.8-5.2）和 1%（95%可信区间 0.8-1.3）。无法活动、恶心和疼痛控制不佳是 SDD 失败的常见原因。总体患者满意度为 94%。
结论
本系统评价和荟萃分析发现，在选择和未选择的患者异质队列中，UKA 后 SDD 的总体成功率为 88%。再入院率、并发症发生率和再次手术率表明 UKA 可以作为一种当日出院的安全有效的手术。
证据等级
三级和四级研究的系统评价，四级证据。
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