Belay Elshaday, Kelly Patrick, Anastasio Albert, Cochrane Niall, Wu Mark, Seyler Thorsten
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Hip Pelvis. 2022 Dec;34(4):227-235. doi: 10.5371/hp.2022.34.4.227. Epub 2022 Dec 3.
Outpatient classified total hip arthroplasty (THA) is a safe option for a select group of patients. An analysis of a national database was conducted to understand the risk factors for unplanned discharge to a skilled nursing facility (SNF) or acute rehabilitation (rehab) after outpatient classified THA.
A query of the National Surgical Quality Improvement Program (NSQIP) database for THA (Current Procedural Terminology [CPT] 27130) performed from 2015 to 2018 was conducted. Patient demographics, American Society of Anesthesiologists (ASA) classification, functional status, NSQIP morbidity probability, operative time, length of stay (LOS), 30-day reoperation rate, readmission rate, and associated complications were collected.
A total of 2,896 patients underwent outpatient classified THA. The mean age of patients was 61.2 years. The mean body mass index (BMI) was 29.6 kg/m with median ASA 2. The results of univariate comparison of SNF/rehab versus home discharge showed that a significantly higher percentage of females (58.7% vs. 46.8%), age >70 years (49.3% vs. 20.9%), ASA ≥3 (58.0% vs. 25.8%), BMI >35 kg/m (23.3% vs. 16.2%), and hypoalbuminemia (8.0% vs. 1.5%) (<0.0001) were discharged to SNF/rehab. The results of multivariable logistic regression showed that female sex (odds ratio [OR] 1.47; =0.03), age >70 years (OR 3.08; =0.001), ASA ≥3 (OR 2.56; =0.001), and preoperative hypoalbuminemia (<3.5 g/dL) (OR 3.76; =0.001) were independent risk factors for SNF/rehab discharge.
Risk factors associated with discharge to a SNF/rehab after outpatient classified THA were identified. Surgeons will be able to perform better risk stratification for patients who may require additional postoperative intervention.
门诊分类全髋关节置换术（THA）对于特定患者群体而言是一种安全的选择。我们对一个国家数据库进行了分析，以了解门诊分类THA后计划外转至专业护理机构（SNF）或急性康复机构（康复机构）的风险因素。
对2015年至2018年期间国家外科质量改进计划（NSQIP）数据库中进行THA（当前手术操作术语[CPT]27130）的记录进行查询。收集患者人口统计学信息、美国麻醉医师协会（ASA）分级、功能状态、NSQIP发病概率、手术时间、住院时间（LOS）、30天再次手术率、再入院率及相关并发症。
共有2896例患者接受了门诊分类THA。患者的平均年龄为61.2岁。平均体重指数（BMI）为29.6kg/m²，ASA中位数为2。SNF/康复机构出院与居家出院的单因素比较结果显示，转至SNF/康复机构的女性比例显著更高（58.7%对46.8%）、年龄>70岁（49.3%对20.9%）、ASA≥3（58.0%对25.8%）、BMI>35kg/m²（23.3%对16.2%）以及低白蛋白血症（8.0%对1.5%）（<0.0001）。多变量逻辑回归结果显示，女性（优势比[OR]1.47；P=0.03）、年龄>70岁（OR 3.08；P=0.001）、ASA≥3（OR 2.56；P=0.001）以及术前低白蛋白血症（<3.5g/dL）（OR 3.76；P=0.001）是转至SNF/康复机构出院的独立风险因素。
确定了门诊分类THA后转至SNF/康复机构出院的风险因素。外科医生将能够对可能需要额外术后干预的患者进行更好的风险分层。
