Ohmori Takaaki, Fraval Andrew, Hozack William J
Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
J Arthroplasty. 2024 Sep;39(9):2311-2315. doi: 10.1016/j.arth.2024.04.050. Epub 2024 Apr 20.
This study aimed to characterize changes in patient demographics and outcomes for same-day discharge total hip arthroplasty (THA) over a 10-year period at a single orthopaedic specialty hospital.
A consecutive series of 1,654 patients between 2013 and 2022 who underwent unilateral THA and were discharged on the same calendar day were retrospectively reviewed. Patient demographics, including age, sex, body mass index (BMI), age-adjusted Charlson Comorbidity Index, and American Society of Anesthesiologists (ASA), were collected. Readmissions, complications, and unplanned visits were recorded for 90 days postoperatively. In order to compare the demographics of patients over time, patients were divided into 3 groups: Time Group A (2013 to 2016), Time Group B (2017 to 2019), and Time Group C (2020 to 2022).
The mean age, BMI, ASA score, and CCI increased significantly across each time group. Age increased from 57 years (range, 23 to 77) to 60 years (range, 20 to 87). The BMI increased from 28.1 (range, 18 to 41) to 29.4 (range, 18 to 47). The percentage of patients aged > 70 years almost doubled over time, as did the percentage of patients who had a BMI > 35. Overall complications increased from 3.44 to 6.82%, reflective of the changing health status of patients. Readmissions increased from 0.57 to 1.70% over time. Despite this, there were no readmissions for any patient within the first 24 hours of surgery.
Our study has 3 important findings. We identified a worsening patient demographic over time with an increasing percentage of patients of advanced age and higher BMI, ASA, and age-adjusted Charlson Comorbidity Index. Also, there was also an increase in readmissions, complications, and unplanned visits. In addition, despite this worsening patient demographic, there were no readmissions within 24 hours and a low rate of readmissions or unplanned visits within the first 48 hours across all time periods, suggesting that same-day discharge-THA continues to be safe in properly selected patients.
本研究旨在描述一家骨科专科医院在10年期间同日出院的全髋关节置换术（THA）患者的人口统计学变化和治疗结果。
回顾性分析了2013年至2022年间连续接受单侧THA并在同日出院的1654例患者。收集患者的人口统计学资料，包括年龄、性别、体重指数（BMI）、年龄校正的Charlson合并症指数和美国麻醉医师协会（ASA）分级。记录术后90天内的再入院情况、并发症和非计划就诊情况。为了比较不同时期患者的人口统计学特征，将患者分为3组：时间组A（2013年至2016年）、时间组B（2017年至2019年）和时间组C（2020年至2022年）。
各时间组患者的平均年龄、BMI、ASA评分和CCI均显著增加。年龄从57岁（范围23至77岁）增加到60岁（范围20至87岁）。BMI从28.1（范围18至41）增加到29.4（范围18至47）。70岁以上患者的比例随时间几乎翻倍，BMI>35的患者比例也是如此。总体并发症从3.44%增加到6.82%，反映了患者健康状况的变化。再入院率随时间从0.57%增加到1.70%。尽管如此，在手术的前24小时内没有患者再次入院。
我们的研究有3个重要发现。我们发现随着时间的推移，患者人口统计学特征恶化，高龄、高BMI、高ASA分级和年龄校正的Charlson合并症指数的患者比例增加。此外，再入院、并发症和非计划就诊也有所增加。此外，尽管患者人口统计学特征恶化，但在所有时间段内，24小时内均无再入院情况，且48小时内再入院或非计划就诊率较低，这表明在适当选择的患者中，同日出院的THA仍然是安全的。
