Department of Orthopaedic surgery, Hannover Medical School, Anna-von-Borriesstr. 1-7, 30625, Hannover, Germany.
Arch Orthop Trauma Surg. 2024 Jun;144(6):2519-2525. doi: 10.1007/s00402-024-05331-4. Epub 2024 May 7.
Early mobilisation after periacetabular osteotomy (PAO) represents an important goal after surgery. The purpose of this study was to determine whether the use of epidural aznalgesia (EA) is associated with prolonged immobility and an increased length of stay (LOS) after PAO surgery.
From January 2022 to July 2023, the study included a cohort of 150 PAO procedures all performed by the same surgeon (SSA). Patients were categorized into two distinct groups: those who received epidural analgesia (EA) (79 PAOs) and those who did not receive EA (71 PAOs). "Ready for discharge" was defined as the ability to ascend and descend a standardized flight of stairs independently. Multivariable linear regression was used to identify additional factors influencing LOS after PAO.
Patients in the EA group were ready for discharge 5.95 ± 2.09 days after surgery which was significantly longer than in the No EA group´s average of 4.18 days ± 2.5, (p < 0.001). While the reduction in the number of patients experiencing pulmonary embolism in the No EA group did not reach statistical significance, it still demonstrated a relevant decrease from two patients within the EA group (2.53%) to 0 (0%) in the No EA group. The active engagement of the surgeon in mobilising patients led to a substantial reduction in LOS, decreasing it from 5.81 ± 2.18 days to 2.2 ± 0.77 days (p < 0.001). Multivariable analysis revealed five independent factors influencing the LOS following PAO which included absence of EA, surgeon-led mobilisation within 24 h after surgery, postoperative hemoglobin levels, BMI, and prior experience with PAO surgery on the contralateral side.
Opting against the use of EA in patients undergoing PAO is advisable, as it will result in extended postoperative immobility and the associated risks. Additionally, the active participation of the surgeon in the mobilisation process is strongly recommended.
髋臼周围截骨术（PAO）后早期活动是术后的重要目标。本研究旨在确定硬膜外镇痛（EA）的使用是否与 PAO 手术后的长时间卧床和住院时间（LOS）延长有关。
2022 年 1 月至 2023 年 7 月，本研究纳入了由同一位外科医生（SSA）完成的 150 例 PAO 手术的队列。患者分为两组：接受硬膜外镇痛（EA）的患者（79 例 PAO）和未接受 EA 的患者（71 例 PAO）。“准备出院”定义为能够独立上下标准楼梯的能力。多变量线性回归用于确定影响 PAO 后 LOS 的其他因素。
EA 组患者术后 5.95±2.09 天准备出院，明显长于无 EA 组的平均 4.18±2.5 天（p<0.001）。虽然无 EA 组中肺栓塞患者数量减少未达到统计学意义，但仍从 EA 组的 2 例（2.53%）降至无 EA 组的 0 例（0%），这一变化具有相关性。外科医生积极主动地让患者活动，使 LOS 显著减少，从 5.81±2.18 天减少到 2.2±0.77 天（p<0.001）。多变量分析显示，有五个独立因素影响 PAO 后的 LOS，包括不使用 EA、术后 24 小时内由外科医生主导的活动、术后血红蛋白水平、BMI 和对侧 PAO 手术的既往经验。
不建议在接受 PAO 的患者中使用 EA，因为这会导致术后长时间卧床和相关风险。此外，强烈建议外科医生积极参与患者的活动过程。
