Camillieri Susan
Rusk Rehabilitation at NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
Nova Southeastern University, Fort Lauderdale, FL, USA.
HSS J. 2024 Feb;20(1):83-89. doi: 10.1177/15563316231208454. Epub 2023 Oct 28.
Advancements in surgical procedures for total joint arthroplasty (TJA) have resulted in more effective procedures with more rapid recovery. To prepare patients for surgery, many organizations offer a preoperative "joint class," which has been associated with reduced length of stay (LOS). Virtual modes of education are increasingly favored for those having TJA.
To determine whether participation in an individually administered preoperative educational session ("Prehab") relates to reduced LOS or increased likelihood of same-day discharge (SDD) for those undergoing TJA. Additionally, to establish whether and the virtual mode of education provision is superior or inferior to the in-person mode with regards to LOS benefits.
The author conducted a case-control study of 2532 patients who had a primary or revision TJA between January 2022 and August 2022 at a single institution. Data were obtained from the electronic medical record. A total of 1118 patients attended Prehab; 1414 patients did not. Patients were included if they were over the age of 18 and had a total hip arthroplasty (THA) or total knee arthroplasty (TKA) during the study period. -tests, chi-square χ tests, and binomial logistic regression were used to evaluate the LOS and SDD outcomes for those who participated in Prehab compared with those who did not.
Those receiving Prehab in any form had shorter LOS than those who had not. Those receiving virtual Prehab had the shortest LOS. There was no difference in the rate of SDD for outpatient-class patients.
Preoperative education is associated with LOS benefits to patients undergoing TJA. The virtual mode of education provision is at minimum non-inferior, and may be superior, to the in-person mode. The lack of statistically significant between-group differences for SDD outcomes may be explained by a lack of SDD-specific educational content provided during Prehab.
全关节置换术（TJA）外科手术的进展带来了更有效的手术方式以及更快的康复速度。为让患者做好手术准备，许多机构提供术前“关节课程”，这与缩短住院时间（LOS）相关。虚拟教育模式越来越受到接受TJA患者的青睐。
确定参加个体化术前教育课程（“术前康复训练”）是否与接受TJA患者的住院时间缩短或当日出院（SDD）可能性增加有关。此外，确定在住院时间获益方面，虚拟教育提供模式与面对面教育模式相比是更优还是更劣。
作者对2022年1月至2022年8月在单一机构接受初次或翻修TJA的2532例患者进行了病例对照研究。数据从电子病历中获取。共有1118例患者参加了术前康复训练；1414例患者未参加。纳入研究的患者年龄超过18岁，且在研究期间接受了全髋关节置换术（THA）或全膝关节置换术（TKA）。采用t检验、卡方（χ²）检验和二项逻辑回归来评估参加术前康复训练的患者与未参加者相比的住院时间和当日出院结局。
接受任何形式术前康复训练的患者住院时间均短于未接受者。接受虚拟术前康复训练的患者住院时间最短。门诊课程患者的当日出院率无差异。
术前教育与接受TJA患者的住院时间获益相关。虚拟教育提供模式至少不劣于，甚至可能优于面对面教育模式。术前康复训练期间缺乏针对当日出院的特定教育内容，可能解释了两组在当日出院结局上缺乏统计学显著差异的原因。
