Department of Anesthesia, University of Miami Miller School of Medicine, Miami, FL, USA.
Cleveland Clinic Foundation, Cleveland, OH, USA.
Curr Pain Headache Rep. 2024 Oct;28(10):971-983. doi: 10.1007/s11916-024-01266-y. Epub 2024 May 29.
To explore the recent developments and trends in the anesthetic and surgical practices for total hip and total knee arthroplasty and discuss the implications for further outpatient total joint arthroplasty procedures.
Between 2012 and 2017 there was an 18.9% increase in the annual primary total joint arthroplasty volume. Payments to physicians falling by 7.5% (14.9% when adjusted for inflations), whereas hospital reimbursements and charges increased by 0.3% and 18.6%, respectively. Total knee arthroplasty and total hip arthroplasty surgeries were removed from the Medicare Inpatient Only in January 2018 and January 2020, respectively leading to same-day TKA surgeries increases from 1.2% in January 2016 to 62.4% by December 2020 Same-day volumes for THA surgery increased from 2% in January 2016 to 54.5% by December 2020. Enhanced Recovery After Surgery (ERAS) protocols have revolutionized modern anesthesia and surgery practices. Centers for Medicare Services officially removed total joint arthroplasty from the inpatient only services list, opening a new door for improved cost savings to patients and the healthcare system alike. In the post-COVID healthcare system numerous factors have pushed increasing numbers of total joint arthroplasties into the outpatient, ambulatory surgery center setting. Improved anesthesia and surgical practices in the preoperative, intraoperative, and postoperative settings have revolutionized pain control, blood loss, and ambulatory status, rendering costly hospital stays obsolete in many cases. As the population ages and more total joint procedures are performed, the door is opening for more orthopedic procedures to exit the inpatient only setting in favor of the ambulatory setting.
探讨全髋关节和全膝关节置换术的麻醉和手术实践的最新进展，并讨论其对进一步开展门诊全关节置换术的影响。
2012 年至 2017 年，初次全关节置换术的年手术量增加了 18.9%。支付给医生的费用下降了 7.5%（经通胀调整后为 14.9%），而医院报销和收费分别增长了 0.3%和 18.6%。全膝关节置换术和全髋关节置换术分别于 2018 年 1 月和 2020 年 1 月从医疗保险仅限住院服务中移除，导致同一天进行的 TKA 手术从 2016 年 1 月的 1.2%增加到 2020 年 12 月的 62.4%。同一天进行的 THA 手术量从 2016 年 1 月的 2%增加到 2020 年 12 月的 54.5%。术后快速康复（ERAS）方案彻底改变了现代麻醉和手术实践。医疗保险和医疗补助服务中心正式将全关节置换术从仅限住院服务清单中移除，为患者和医疗保健系统节省成本开辟了新的途径。在后 COVID-19 医疗保健系统中，许多因素将越来越多的全关节置换术推向门诊、日间手术中心环境。术前、术中和术后麻醉和手术实践的改进彻底改变了疼痛控制、失血量和活动能力，使许多情况下昂贵的住院治疗变得过时。随着人口老龄化和更多全关节手术的开展，越来越多的骨科手术开始从仅限住院服务转变为门诊服务。
