Orthopedics. 2024 Jan-Feb;47(1):e38-e44. doi: 10.3928/01477447-20230426-08. Epub 2023 May 2.
Outpatient total hip arthroplasty (THA) is a safe option for select patients. The purpose of this study was to analyze a national database and understand risk factors that lead to unplanned early readmission and reoperation after outpatient THA. The National Surgical Quality Improvement Program database was used to collect outpatient THAs performed from 2013 to 2020. The outpatient setting was defined as a reported hospital length of stay of 23 hours or less. Data variables collected included patient demographics, medical comorbidities, American Society of Anesthesiologists classification, functional status, preoperative laboratory values, National Surgical Quality Improvement Program morbidity probability, and 30-day readmissions and reoperations. A total of 15,055 patients underwent outpatient THA. Mean age was 62.6 years, and 52.1% of patients were men. Mean body mass index was 29.3 kg/m. The overall rate of readmission was 1.8%, and the reoperation rate was 1.0%. Patients with a 30-day readmission were older (<.01), with a higher incidence of hypertension (<.01), steroid use (<.01), and bleeding disorders (=.01). Patients with a 30-day reoperation had higher body mass index (<.01), hypertension (<.01), and steroid use (<.01). Regression analysis demonstrated that independent risk factors for readmission were age (<.01) and steroid use (<.01). Risk factors for 30-day reoperation were hypertension (<.01) and steroid use (<.01). There is a higher risk of early readmission after outpatient THA for older patients with hypertension, bleeding disorders, and steroid use. Patients with hypertension and steroid use have a higher risk for reoperation after outpatient THA. Modifiable risk factors should be addressed preoperatively, with proper patient selection for outpatient THA. [. 2024;47(1):e38-e44.].
门诊全髋关节置换术(THA)是一种安全的选择,适用于特定患者。本研究旨在分析国家数据库,了解导致门诊 THA 后计划外早期再入院和再次手术的风险因素。使用国家手术质量改进计划数据库收集了 2013 年至 2020 年期间进行的门诊 THA。门诊设置定义为报告的住院时间为 23 小时或更短。收集的数据变量包括患者人口统计学特征、合并症、美国麻醉医师协会分类、功能状态、术前实验室值、国家手术质量改进计划发病率概率以及 30 天再入院和再次手术。共有 15055 例患者接受了门诊 THA。平均年龄为 62.6 岁,52.1%的患者为男性。平均体重指数为 29.3kg/m。总的再入院率为 1.8%,再次手术率为 1.0%。30 天再入院的患者年龄较大(<.01),高血压(<.01)、类固醇使用(<.01)和出血性疾病(=.01)的发生率较高。30 天内再次手术的患者体重指数较高(<.01)、高血压(<.01)和类固醇使用(<.01)。回归分析表明,再入院的独立危险因素是年龄(<.01)和类固醇使用(<.01)。30 天内再次手术的危险因素是高血压(<.01)和类固醇使用(<.01)。患有高血压、出血性疾病和类固醇使用的老年门诊 THA 患者术后早期再入院的风险较高。患有高血压和类固醇使用的患者门诊 THA 后再次手术的风险较高。应在术前解决可改变的危险因素,并对门诊 THA 进行适当的患者选择。[. 2024;47(1):e38-e44.].