COVID-19大流行期间全关节置换术后当日出院率的增加对患者预后无影响：一项回顾性队列分析
An Increase in Same-day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence Patient Outcomes: A Retrospective Cohort Analysis.
作者信息
Mitchell Brook A, Cleary Liam M, Samuel Linsen T, Coobs Benjamin R, Thomas Miles A, Martinkovich Stephen C, Moskal Joseph T
机构信息
Virginia Tech Carilion School of Medicine, Carilion Clinic, Roanoke, VA, USA.
Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, Roanoke, VA, USA.
出版信息
Arthroplast Today. 2023 Apr;20:101115. doi: 10.1016/j.artd.2023.101115. Epub 2023 Feb 8.
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic caused major transitions in total joint arthroplasty (TJA), notably with the increased utilization of same-day discharge (SDD) pathways. This study assessed the effect of accelerated discharge pathways following the resumption of elective cases during the COVID-19 pandemic on SDD rates, adverse events, and characteristics associated with successful SDD following total hip and total knee arthroplasty.
METHODS
This retrospective study split patients into cohorts: TJA prior to COVID-19 (pre-COVID, July 2019-December 2019) and TJA following the resumption of elective surgeries (post-COVID, July 2020-December 2020). Patient characteristics such as age, sex, body mass index, American Society of Anesthesiologists score, and pertinent comorbidities were analyzed, and length of stay, 30-day emergency department (ED) visit rates, readmissions, and reoperations were compared.
RESULTS
A total of 1333 patients met inclusion criteria that were divided into pre-COVID (692) and post-COVID (641) cohorts. The pre-COVID group had a median age of 69 years (interquartile range 63-76), and the post-COVID group had a median age of 68 years (interquartile range 61-75) ( = .024). SDD increased from 0.1% to 28.9% ( < .001), and length of stay decreased from 1.3 days to 0.89 days ( < .001). There was no change in 30-day ED visits, readmissions, or reoperations ( = .817, = .470, and = .643, respectively). There was no difference in ED visits, readmissions, or reoperations in SDD patients. The odds of SDD were associated with age ( < .001, odds ratio [OR] = 0.94), body mass index ( = .006, OR = 0.95), male sex ( < .001, OR = 1.83), and history of tobacco use ( < .001, OR = 1.87).
CONCLUSIONS
At our institution, the COVID-19 pandemic accelerated the utilization of SDD pathways without increasing ED visits, readmissions, or reoperations.
背景
2019年冠状病毒病（COVID-19）大流行导致全关节置换术（TJA）发生了重大转变，尤其是当日出院（SDD）途径的使用增加。本研究评估了COVID-19大流行期间择期手术恢复后加速出院途径对全髋关节和全膝关节置换术后SDD率、不良事件以及与成功SDD相关特征的影响。
方法
这项回顾性研究将患者分为队列：COVID-19之前的TJA（COVID前，2019年7月至2019年12月）和择期手术恢复后的TJA（COVID后，2020年7月至2020年12月）。分析患者特征，如年龄、性别、体重指数、美国麻醉医师协会评分和相关合并症，并比较住院时间、30天急诊科（ED）就诊率、再入院率和再次手术率。
结果
共有1333名患者符合纳入标准，分为COVID前队列（692例）和COVID后队列（641例）。COVID前组的中位年龄为69岁（四分位间距63 - 76），COVID后组的中位年龄为68岁（四分位间距61 - 75）（P = 0.024）。SDD从0.1%增加到28.9%（P < 0.001），住院时间从1.3天减少到0.89天（P < 0.001）。30天ED就诊、再入院或再次手术无变化（分别为P = 0.817、P = 0.470和P = 0.643）。SDD患者的ED就诊、再入院或再次手术无差异。SDD的几率与年龄（P < 0.001，比值比[OR]=0.94）、体重指数（P = 0.006，OR = 0.95）、男性（P < 0.001，OR = 1.83）和吸烟史（P < 0.001，OR = 1.87）相关。
结论
在我们机构，COVID-19大流行加速了SDD途径的使用，而未增加ED就诊、再入院或再次手术。
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