Kouyoumdjian Pascal, Brichni Malek, Marchand Philippe, Coulomb Rémy
Centre Hospitalier Universitaire de Nîmes, Nîmes, France.
Laboratoire de Génie Civil et Génie Mécanique, Rennes, France.
Arch Orthop Trauma Surg. 2025 Jan 25;145(1):146. doi: 10.1007/s00402-025-05767-2.
The adoption of robotic-assisted total hip arthroplasty (THA) is increasingly widespread, yet its influence on outcomes in outpatient surgery remains uncertain. This study aimed to evaluate whether robotic assistance reduces the rate of 90-day postoperative events in patients undergoing outpatient THA, compared to those in inpatient procedures.
This historical-prospective cohort study analyzed 706 primary THA cases performed between January 2017 and January 2023 by three senior surgeons. Patients were grouped into outpatient (n = 132) and inpatient (n = 576) cohorts. From December 2019, robotic-assisted THA using the MAKO™ system was implemented. Propensity score matching was used to minimize baseline differences between groups. The primary outcome was the occurrence of any event within 90 days post-surgery, including readmissions, reoperations, and other complications. Secondary outcomes included functional scores, length of hospital stay, and intraoperative factors such as blood loss and Operative Room (OR) time.
No significant differences were found between inpatient and outpatient groups in terms of gender, age, BMI, ASA score, or surgeon. The 90-day event rates were similar between the two groups (8.59% vs. 9.38%, p > 0.999). However, outpatient THA was associated with lower blood loss (p = 0.02) and shorter hospital stays (p < 0.001). Multivariate analysis identified prolonged OR time (> 2 h), BMI ≥ 25, and manual surgical techniques as significant risk factors for 90-day events. Robotic-assisted surgery, although not statistically significant (p = 0.105), showed a trend towards reducing complications in outpatient THA.
Outpatient THA is a safe alternative to inpatient surgery, with no significant difference in 90-day postoperative events. Robotic-assisted surgery appears to reduce complications, particularly in the outpatient setting, and may optimize outpatient care pathways. Further research is needed to confirm these findings and explore long-term outcomes.
III.
机器人辅助全髋关节置换术（THA）的应用日益广泛，但其对门诊手术结果的影响仍不确定。本研究旨在评估与住院手术相比，机器人辅助是否能降低门诊THA患者术后90天内事件的发生率。
这项历史前瞻性队列研究分析了2017年1月至2023年1月期间由三位资深外科医生进行的706例初次THA病例。患者被分为门诊（n = 132）和住院（n = 576）队列。从2019年12月起，开始实施使用MAKO™系统的机器人辅助THA。采用倾向评分匹配法以尽量减少组间基线差异。主要结局是术后90天内发生的任何事件，包括再次入院、再次手术和其他并发症。次要结局包括功能评分、住院时间以及术中因素如失血和手术室（OR）时间。
住院组和门诊组在性别、年龄、BMI、ASA评分或外科医生方面未发现显著差异。两组的90天事件发生率相似（8.59%对9.38%，p > 0.999）。然而，门诊THA的失血量较少（p = 0.02），住院时间较短（p < 0.001）。多变量分析确定手术时间延长（> 2小时）、BMI≥25和手动手术技术是90天事件的重要危险因素。机器人辅助手术虽然无统计学意义（p = 0.105），但在门诊THA中显示出降低并发症的趋势。
门诊THA是住院手术的一种安全替代方案，术后90天事件无显著差异。机器人辅助手术似乎能降低并发症，尤其是在门诊环境中，并且可能优化门诊护理路径。需要进一步研究来证实这些发现并探索长期结局。
III级
