Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut; University Orthopedics Inc, East Providence, Rhode Island.
J Arthroplasty. 2024 Feb;39(2):398-401. doi: 10.1016/j.arth.2023.08.034. Epub 2023 Aug 17.
Primary total hip arthroplasty (THA) is increasingly being performed in the outpatient setting. However, there is little known regarding the differences in same-day discharge (SDD) rates and complications of operative approach in same-day total hip arthroplasty in the ambulatory surgery center (ASC) setting.
A retrospective chart review was performed between July 2019 and October 2021 for all patients who underwent primary THA in a single freestanding ASC. Successful SDDs, surgical approaches, lengths of surgery, estimated blood losses (EBL), complications, and readmission events were recorded for each patient. Complications were compared using Pearson Chi-Squares, while EBL and surgery lengths were compared with 1-way analysis of variances (ANOVA) (alpha = 0.5). There were 17 total complications in 326 total hip arthroplasties (5.2%), including direct admissions to the emergency department, 30-day and 90-day readmissions, wound complications, instability, infection, and revision surgery. Among all complications, there were 5 direct admissions, making the successful SDD rate 98.5%.
Complications and direct admissions were not associated with approach. The 30-day readmission rates were associated with approach, with no readmissions in the direct anterior approach (DAA) or the antero-lateral approach (AL) cohorts and 3 (4.3%) in the posterior approach (PA) cohort.
In the ASC setting, patients undergoing THA regardless of approach showed no difference in successful SDDs or complications aside from 30-day readmissions. Same-day THA can be safely performed in the DAA, AL, and PA to the hip.
初次全髋关节置换术（THA）越来越多地在门诊环境中进行。然而，对于在门诊手术中心（ASC）环境中全髋关节置换术的当日出院（SDD）率和手术入路的差异知之甚少。
对 2019 年 7 月至 2021 年 10 月期间在一个独立的 ASC 中接受初次 THA 的所有患者进行回顾性图表审查。记录每位患者的 SDD 成功率、手术入路、手术时长、估计失血量（EBL）、并发症和再入院事件。使用 Pearson 卡方检验比较并发症，使用单因素方差分析（ANOVA）比较 EBL 和手术时长（α=0.5）。在 326 例全髋关节置换术中，共有 17 例并发症（5.2%），包括直接收入急诊部、30 天和 90 天再入院、伤口并发症、不稳定、感染和翻修手术。在所有并发症中，有 5 例直接入院，SDD 成功率为 98.5%。
并发症和直接入院与入路无关。30 天再入院率与入路有关，直接前路（DAA）或前外侧入路（AL）队列中无再入院，后入路（PA）队列中有 3 例（4.3%）。
在 ASC 环境中，无论采用何种入路，接受 THA 的患者在 SDD 成功率和并发症方面没有差异，除了 30 天再入院率。DAA、AL 和 PA 均可安全用于髋关节的当日 THA。
