Anderson Orthopaedic Research Institute, Alexandria, Virginia.
J Arthroplasty. 2023 Nov;38(11):2295-2300. doi: 10.1016/j.arth.2023.05.018. Epub 2023 May 18.
Literature suggests that outpatient arthroplasty may result in low rates of complications and readmissions. There is, however, a dearth of information on the relative safety of total knee arthroplasty (TKA) performed at stand-alone ambulatory surgery centers (ASCs) versus hospital outpatient (HOP) settings. We aimed to compare safety profiles and 90-day adverse events of these 2 cohorts.
Prospectively collected data were reviewed on all patients who underwent outpatient TKA from 2015 to 2022. The ASC and HOP groups were compared, and differences in demographics, complications, reoperations, revisions, readmissions, and emergency department (ED) visits within 90 days of surgery were analyzed. There were 4 surgeons who performed 4,307 TKAs during the study period, including 740 outpatient cases (ASC = 157; HOP = 583). The ASC patients were younger than HOP patients (ASC = 61 versus HOP = 65; P < .001). Body mass index and sex did not differ significantly between groups.
Within 90 days, 44 (6%) complications occurred. No differences were observed between groups in rates of 90-day complications (ASC = 9 of 157, 5.7% versus HOP = 35 of 583, 6.0%; P = .899), reoperations (ASC = 2 of 157, 1.3% versus HOP = 3 of 583, 0.5%; P = .303), revisions (ASC = 0 of 157 versus HOP = 3 of 583, 0.5%; P = 1), readmissions (ASC = 3 of 157, 1.9% versus HOP = 8 of 583, 1.4%; P = .625), and ED visits (ASC = 1 of 157, 0.6% versus HOP = 3 of 583, 0.5%; P = .853).
These results suggest that in appropriately selected patients, outpatient TKA can be safely performed in both ASC and HOP settings with similar low rates of 90-day complications, reoperations, revisions, readmissions, and ED visits.
文献表明，门诊关节置换术可能导致并发症和再入院率较低。然而，关于在独立门诊手术中心 (ASC) 与医院门诊 (HOP) 环境下进行全膝关节置换术 (TKA) 的相对安全性的信息却很少。我们旨在比较这两组患者的安全性概况和 90 天内的不良事件。
对 2015 年至 2022 年期间所有接受门诊 TKA 的患者进行前瞻性收集数据。比较 ASC 和 HOP 组，分析两组患者在人口统计学、并发症、再次手术、翻修、再入院和术后 90 天内急诊就诊等方面的差异。共有 4 位外科医生在研究期间进行了 4307 例 TKA，其中包括 740 例门诊病例 (ASC=157; HOP=583)。ASC 组患者比 HOP 组患者年轻 (ASC=61 岁，HOP=65 岁；P<0.001)。两组患者的体重指数和性别无显著差异。
在 90 天内，发生了 44 例（6%）并发症。两组患者 90 天内并发症发生率无差异 (ASC=157 例中的 9 例，5.7%，HOP=583 例中的 35 例，6.0%；P=0.899)、再次手术率 (ASC=157 例中的 2 例，1.3%，HOP=583 例中的 3 例，0.5%；P=0.303)、翻修率 (ASC=0 例，HOP=583 例中的 3 例，0.5%；P=1)、再入院率 (ASC=157 例中的 3 例，1.9%，HOP=583 例中的 8 例，1.4%；P=0.625)和急诊就诊率 (ASC=157 例中的 1 例，0.6%，HOP=583 例中的 3 例，0.5%；P=0.853)。
这些结果表明，在适当选择的患者中，门诊 TKA 可在 ASC 和 HOP 环境中安全进行，两组患者 90 天内的并发症、再次手术、翻修、再入院和急诊就诊率均较低。
