Danielsen Oddrún, Jensen Christian B, Varnum Claus, Jakobsen Thomas, Andersen Mikkel R, Bieder Manuel J, Overgaard Søren, Jørgensen Christoffer C, Kehlet Henrik, Gromov Kirill, Lindberg-Larsen Martin
Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Svendborg, Denmark.
Bone Jt Open. 2024 Nov 5;5(11):977-983. doi: 10.1302/2633-1462.511.BJO-2024-0125.R1.
Day-case success rates after primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and medial unicompartmental knee arthroplasty (mUKA) may vary, and detailed data are needed on causes of not being discharged. The aim of this study was to analyze the association between surgical procedure type and successful day-case surgery, and to analyze causes of not being discharged on the day of surgery when eligible and scheduled for day-case THA, TKA, and mUKA.
A multicentre, prospective consecutive cohort study was carried out from September 2022 to August 2023. Patients were screened for day-case eligibility using well defined inclusion and exclusion criteria, and discharged when fulfilling predetermined discharge criteria. Day-case eligible patients were scheduled for surgery with intended start of surgery before 1.00 pm.
Of 6,142 primary hip and knee arthroplasties, eligibility rates for day-case surgery were 34% for THA (95% CI 32% to 36%), 34% for TKA (95% CI 32% to 36%), and 52% for mUKA (95% CI 49% to 55%). Surgery before 1.00 pm was achieved in 85% of eligible patients. The day-case success rate among patients with surgery before 1.00 pm was 59% (95% CI 55% to 62%) for THA, 61% (95% CI 57% to 65%) for TKA, and 72% (95% CI 68% to 76%) for mUKA. Overall day-case success rates (eligible and non-eligible) were 19% (95% CI 17% to 20%) for THA, 20% (95% CI 18% to 21%) for TKA, and 42% (95% CI 39% to 45%) for mUKA. Adjusted analysis confirmed higher day-case success in eligible mUKA patients (odds ratio 1.9 (1.6 to 2.3)) compared to TKA and THA patients. Primary causes for day-case failure were mobilization issues (9% to 12% between procedures), prolonged spinal anaesthesia (4% to 9%), and postoperative nausea and vomiting (PONV) (4% to 14%).
THA and TKA patients showed comparable eligibility (34%) with similar day-case success rates (59 to 61%), whereas mUKA patients demonstrated higher eligibility (52%) and day-case success (72%). Mobilization issues, prolonged spinal anaesthesia, and PONV were the most frequent causes for not being discharged.
初次全髋关节置换术（THA）、全膝关节置换术（TKA）和内侧单髁膝关节置换术（mUKA）术后日间手术成功率可能存在差异，需要有关未出院原因的详细数据。本研究的目的是分析手术类型与日间手术成功之间的关联，并分析符合日间手术条件且计划进行日间THA、TKA和mUKA手术的患者在手术当天未出院的原因。
2022年9月至2023年8月进行了一项多中心、前瞻性连续队列研究。使用明确的纳入和排除标准筛选患者的日间手术资格，符合预定出院标准时出院。符合日间手术条件的患者安排在下午1点前开始手术。
在6142例初次髋膝关节置换术中，THA的日间手术资格率为34%（95%CI 32%至36%），TKA为34%（95%CI 32%至36%），mUKA为52%（95%CI 49%至55%）。85%的符合条件患者在下午1点前进行了手术。下午1点前进行手术的患者中，THA的日间手术成功率为59%（95%CI 55%至62%），TKA为61%（95%CI 57%至65%），mUKA为72%（95%CI 68%至76%）。总体日间手术成功率（符合条件和不符合条件），THA为19%（95%CI 17%至20%），TKA为20%（95%CI 18%至21%），mUKA为42%（95%CI 39%至45%）。校正分析证实，与TKA和THA患者相比，符合条件的mUKA患者日间手术成功率更高（优势比1.9（1.6至2.3））。日间手术失败的主要原因是活动问题（各手术之间为9%至12%）、腰麻时间延长（4%至9%）和术后恶心呕吐（PONV）（4%至14%）。
THA和TKA患者的资格率相当（34%），日间手术成功率相似（59%至61%），而mUKA患者的资格率更高（52%），日间手术成功率更高（72%）。活动问题、腰麻时间延长和PONV是未出院的最常见原因。
