Cochrane Niall H, Kim Billy, Seyler Thorsten M, Bolognesi Michael P, Wellman Samuel S, Ryan Sean P
Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, USA.
Bone Joint J. 2022 Dec;104-B(12):1323-1328. doi: 10.1302/0301-620X.104B12.BJJ-2022-0372.R2.
In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and reoperations in patients undergoing revision TKA with a hospital stay greater or less than 24 hours. The authors hypothesized that expedited discharge in select patients would not be associated with increased 30-day readmissions and reoperations.
Aseptic revision TKAs in the National Surgical Quality Improvement Program database were reviewed from 2013 to 2020. TKAs were stratified by length of hospital stay (greater or less than 24 hours). Patient demographic details, medical comorbidities, American Society of Anesthesiologists (ASA) grade, operating time, components revised, 30-day readmissions, and reoperations were compared. Multivariate analysis evaluated predictors of discharge prior to 24 hours, 30-day readmission, and reoperation.
Of 21,610 aseptic revision TKAs evaluated, 530 were discharged within 24 hours. Short-stay patients were younger (63.1 years (49 to 78) vs 65.1 years (18 to 94)), with lower BMI (32.3 kg/m (17 to 47) vs 33.6 kg/m (19 to 54) and lower ASA grades. Diabetes, chronic obstructive pulmonary disease, hypertension, and cancer were all associated with a hospital stay over 24 hours. Single component revisions (56.8% (n = 301) vs 32.4% (n = 6,823)), and shorter mean operating time (89.7 minutes (25 to 275) vs 130.2 minutes (30 to 517)) were associated with accelerated discharge. Accelerated discharge was not associated with 30-day readmission and reoperation.
Accelerated discharge after revision TKA did not increase short-term complications, readmissions, or reoperations. Further efforts to decrease hospital stays in this setting should be evaluated.Cite this article: 2022;104-B(12):1323-1328.
在过去十年中，围手术期的进展扩大了门诊初次全膝关节置换术（TKA）的应用。尽管如此，关于翻修TKA后快速出院的数据仍然有限。本研究比较了住院时间大于或小于24小时的翻修TKA患者的30天再入院率和再次手术率。作者假设，对部分患者进行快速出院不会增加30天再入院率和再次手术率。
回顾2013年至2020年国家外科质量改进计划数据库中的无菌性翻修TKA病例。TKA按住院时间（大于或小于24小时）分层。比较患者的人口统计学细节、合并症、美国麻醉医师协会（ASA）分级、手术时间、翻修的组件、30天再入院率和再次手术率。多因素分析评估了24小时内出院、30天再入院和再次手术的预测因素。
在评估的21610例无菌性翻修TKA中，530例在24小时内出院。短期住院患者更年轻（63.1岁（49至78岁）对65.1岁（18至94岁）），体重指数更低（32.3kg/m²（17至47）对33.6kg/m²（19至54）），ASA分级更低。糖尿病、慢性阻塞性肺疾病、高血压和癌症均与住院时间超过24小时有关。单组件翻修（56.8%（n = 301）对32.4%（n = 6823））和平均手术时间较短（89.7分钟（25至275分钟）对130.2分钟（30至517分钟））与快速出院有关。快速出院与30天再入院和再次手术无关。
翻修TKA后快速出院不会增加短期并发症、再入院率或再次手术率。应评估在这种情况下进一步缩短住院时间的措施。引用本文：2022；104-B(12):1323-1328。
