Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Knee. 2023 Oct;44:158-164. doi: 10.1016/j.knee.2023.08.003. Epub 2023 Sep 4.
This study describes the implementation of Enhanced Recovery After Surgery (ERAS) total knee arthroplasty (TKA) with day-surgery protocol to assess the outcome of ERAS day surgery TKA compared with traditional ERAS inpatient TKA in terms of length of stay (LOS), 30-day readmission, complications, and patient-reported outcome measures (PROMs).
Patients who underwent unilateral primary TKA from August 2020 to July 2021 were followed up. All TKAs were performed with the ERAS protocol. Patients who fulfilled the following inclusion criteria were offered day-surgery protocol: (1) ASA ≤ 3; (2) agreeable for discharge home. In addition, this day-surgery protocol comprised the following: (i) on-call physiotherapy review; (ii) home visit by physiotherapist at 1 week postoperative; (iii) home visit by nurse at 2 weeks postoperative. Day surgery was defined as discharge within 24 h. Patients were followed up for 6 months and PROMs, postoperative complications, and re-admissions recorded.
A total of 738 patients were included (342 ERAS day surgery, 396 ERAS inpatient). 92.4% of patients in the day-surgery group were successfully discharged within 24 h, leading to a shorter mean LOS of 1.13 days compared with 4.12 days in the inpatient group (P < 0.005). Both groups achieved significant and comparable improvement in Knee Society Score, Oxford Knee Score, and Physical and Mental component of Short Form-36. Both groups had similar rate of 30-day readmission and complications.
Patients who underwent ERAS day surgery TKA achieved similar functional and quality of life improvement compared with ERAS inpatient TKA with no increased complication rate. ERAS day surgery TKA is safe and cost effective, and its use should be promoted.
本研究描述了加速康复外科（ERAS）全膝关节置换术（TKA）日间手术方案的实施，旨在评估 ERAS 日间手术 TKA 与传统 ERAS 住院 TKA 在住院时间（LOS）、30 天再入院率、并发症和患者报告的结果测量（PROMs）方面的结果。
对 2020 年 8 月至 2021 年 7 月期间接受单侧初次 TKA 的患者进行随访。所有 TKA 均采用 ERAS 方案进行。符合以下纳入标准的患者被提供日间手术方案：（1）ASA ≤ 3；（2）同意出院回家。此外，该日间手术方案包括以下内容：（i）随叫随到的物理治疗审查；（ii）术后 1 周由物理治疗师上门访问；（iii）术后 2 周由护士上门访问。日间手术定义为 24 小时内出院。患者随访 6 个月，记录 PROMs、术后并发症和再入院情况。
共纳入 738 例患者（ERAS 日间手术组 342 例，ERAS 住院组 396 例）。日间手术组 92.4%的患者成功在 24 小时内出院，与住院组 4.12 天的平均 LOS 相比，明显缩短（P < 0.005）。两组在膝关节学会评分、牛津膝关节评分和健康调查简表-36 的身体和精神成分方面均取得了显著且相似的改善。两组的 30 天再入院率和并发症发生率相似。
与 ERAS 住院 TKA 相比，接受 ERAS 日间手术 TKA 的患者在功能和生活质量改善方面相似，且并发症发生率没有增加。ERAS 日间手术 TKA 安全且具有成本效益，应推广使用。
