膝关节截骨术可在门诊环境中安全进行。
Knee Osteotomies Can Be Performed Safely In An Ambulatory Setting.
作者信息
Doran Michael, Essilfie Anthony A, Hurley Eoghan T, Bloom David A, Manjunath Amit K, Jazrawi Laith M, Strauss Eric J, Alaia Michael J
机构信息
New York University Langone Health, Department of Orthopaedic Surgery, New York, New York, U.S.A.
出版信息
Arthrosc Sports Med Rehabil. 2022 Jun 30;4(4):e1397-e1402. doi: 10.1016/j.asmr.2022.04.028. eCollection 2022 Aug.
PURPOSE
The purpose of this study was to assess the rate of hospital admissions, inpatient conversions, reoperations, and complications associated with tibial tubercle osteotomies (TTO), high tibial osteotomies (HTO), and distal femoral osteotomies (DFO) performed at our ambulatory surgery center compared with our inpatient hospital facility.
METHODS
A retrospective review of patients receiving a TTO, HTO or DFO at our institution between June 2011 and October 2019 was performed. Inclusion criteria consisted of patients undergoing the aforementioned procedures for malalignment, and a minimum of 90-days follow-up. Revision osteotomies, those undergoing an osteotomy for an acute fracture, and those with rule-out criteria for outpatient surgery (ASA > 3, and body mass index >40) were excluded. Complications, including readmission and reoperation, were compared between the two groups using either the Fisher's exact test and independent samples -test, where applicable, and a value of <0.05 was considered to be statistically significant.
RESULTS
The study included 531 patients undergoing osteotomies (222 ambulatory surgical center [ASC] and 309 hospital) with no patients lost to follow-up in the 90-day postoperative period. No patients operated on at an ASC required transfer to inpatient setting. There were no differences in complication rates, readmission, or reoperation rates among the two groups (4.1% vs 4.9%; = .8328; 3.1% vs 4.5%, = .5026; 3.1% vs 4.5%; = .5026; respectively). Complications, including surgical site infection and arthrofibrosis were not significantly different in the two cohorts, (1.4% vs. 2.6%, = .341 and 1.4% vs 1%; = .698, respectively).
CONCLUSIONS
Osteotomies about the knee performed in an ambulatory setting were safe, with no difference in readmission, reoperation, or postoperative complications compared to those performed at an inpatient hospital. Additionally, no patient required conversion from an outpatient to an inpatient setting.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
本研究旨在评估在我们的门诊手术中心与住院医院进行胫骨结节截骨术（TTO）、高位胫骨截骨术（HTO）和股骨远端截骨术（DFO）相关的住院率、住院转换率、再次手术率和并发症发生率，并进行比较。
方法
对2011年6月至2019年10月期间在我们机构接受TTO、HTO或DFO手术的患者进行回顾性研究。纳入标准包括因对线不良接受上述手术且至少随访90天的患者。翻修截骨术、因急性骨折接受截骨术的患者以及不符合门诊手术排除标准（美国麻醉医师协会分级>3级和体重指数>40）的患者被排除。在适用的情况下，使用Fisher精确检验和独立样本检验对两组之间的并发症（包括再次入院和再次手术）进行比较，P值<0.05被认为具有统计学意义。
结果
该研究纳入了531例行截骨术的患者（222例在门诊手术中心[ASC]，309例在医院），术后90天内无患者失访。在ASC接受手术的患者中，无患者需要转至住院环境。两组之间的并发症发生率、再次入院率或再次手术率无差异（分别为4.1%对4.9%；P = 0.8328；3.1%对4.5%，P = 0.5026；3.1%对4.5%；P = 0.5026）。两组中包括手术部位感染和关节纤维化在内的并发症无显著差异（分别为1.4%对2.6%，P = 0.341和1.4%对1%；P = 0.698）。
结论
在门诊环境中进行的膝关节周围截骨术是安全的，与在住院医院进行的手术相比，再次入院、再次手术或术后并发症方面无差异。此外，没有患者需要从门诊转换为住院环境。
证据水平
三级，回顾性比较研究。
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