Jefferson Health New Jersey, Stratford, New Jersey.
Rothman Orthopaedic Institute, Egg Harbor Township, New Jersey.
J Arthroplasty. 2024 Jan;39(1):8-12. doi: 10.1016/j.arth.2023.06.020. Epub 2023 Jun 17.
Same calendar day discharge (SCDD) following total joint arthroplasty is desirable for patients and surgeons alike. The aim of this study was to compare the success rate of SCDD in an ambulatory surgical center (ASC) versus hospital setting.
A retrospective analysis was performed on 510 patients who underwent primary hip and knee total joint arthroplasty over a 2-year period. The final cohort was divided into 2 groups based on location of surgery: ASC (N = 255) or hospital (N = 255). Groups were matched for age, sex, body mass index, American Society of Anesthesiologists score, and Charleston Comorbidity Index. Successes of SCDD, reasons for failure of SCDD, length of stay (LOS), and 90-day readmission and complication rates were recorded.
All SCDD failures were from the hospital setting (36 [65.6%] total knee arthroplasty [TKA] and 19 [34.5%] total hip arthroplasty [THA]). There were no failures from the ASC. The main causes of failed SCDD in both THA and TKA included failed physical therapy and urinary retention. Regarding THA, the ASC group had a significantly shorter total LOS (6.8 [4.4 to 11.6] versus 12.8 [4.7 to 58.0] hours, P < .001). Similarly, TKA patients had a shorter LOS in the ASC (6.9 [4.6 to 12.9] versus 16.9 [6.1 to 57.0], P < .001). Total 90-day readmission rates were higher in the ASC group (2.75% versus 0%), where all but 1 patient underwent TKA. Similarly, complication rates were higher in the ASC group (8.2% versus 2.75%), where all but 1 patient underwent TKA.
TJA performed in the ASC, compared to the hospital setting, allowed for reduced LOS and improved success of SCDD.
全关节置换术后同一天出院（SCDD）对患者和外科医生都很理想。本研究的目的是比较在门诊手术中心（ASC）和医院环境下 SCDD 的成功率。
对 2 年内接受初次髋关节和膝关节全关节置换术的 510 例患者进行回顾性分析。最终队列根据手术地点分为 2 组：ASC（N=255）或医院（N=255）。两组在年龄、性别、体重指数、美国麻醉医师协会评分和Charleston 合并症指数方面相匹配。记录 SCDD 的成功率、SCDD 失败的原因、住院时间（LOS）和 90 天再入院率和并发症发生率。
所有 SCDD 失败均来自医院环境（36 例[65.6%]全膝关节置换术[TKA]和 19 例[34.5%]全髋关节置换术[THA]）。ASC 无失败病例。THA 和 TKA 中 SCDD 失败的主要原因包括物理治疗失败和尿潴留。对于 THA，ASC 组的总 LOS 明显更短（6.8[4.4 至 11.6]小时与 12.8[4.7 至 58.0]小时，P<0.001）。同样，TKA 患者在 ASC 中的 LOS 更短（6.9[4.6 至 12.9]与 16.9[6.1 至 57.0]，P<0.001）。ASC 组的 90 天再入院率更高（2.75%与 0%），其中除 1 例患者外均接受 TKA 治疗。同样，ASC 组的并发症发生率更高（8.2%与 2.75%），其中除 1 例患者外均接受 TKA 治疗。
与医院环境相比，在 ASC 进行的 TJA 可缩短 LOS 并提高 SCDD 的成功率。
