Marshall Alexandra, Parisien Ariane, Ojaghi Reza, Poitras Stéphane, Beaulé Paul E
Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
The Ottawa Hospital Research Institute, Orthopaedic Research, Ottawa, Ontario, Canada.
J Arthroplasty. 2025 Aug;40(8S1):S49-S54. doi: 10.1016/j.arth.2025.03.036. Epub 2025 Mar 17.
Timely access for young patients who have hip dysplasia can be challenging due to health system resource limitations such as operating room access and hospital beds. This study evaluated the safety and effectiveness of same-day discharge (SDD) periacetabular osteotomy (PAO).
There were 59 consecutive patients (mean age 30 years; range, 17 to 50; 60% women) scheduled for SDD. There were 47 outpatients matched with 47 inpatients based on age and a body mass index (BMI). Outpatients had a mean age of 28 years (range, 17 to 46) and BMI of 25.6 (range, 18.9 to 37.1), compared to inpatients between 2015 and 2020 (mean age 28 years, range, 16 to 44; BMI 25.9, range, 19.4 to 34.7). All patients received general anesthesia with multimodal pain management. In the outpatient group, 46.8% had adjunct procedures, compared to 34.0% in the inpatient group. Outcomes included revisits to the emergency department, readmissions, and adverse events (using the modified Sink Dindo Classification).
There were six outpatients (12.8%) who stayed in the hospital for more than 24 hours, with three planned and three having failed to be discharged the same day, averaging a length of stay of 10.1 hours (range, 5.7 to 23.8). The mean length of stay for inpatients was 3.03 days (range, 1.03 to 11.8). None of the unmatched patients had an SDD. Mean outpatient blood loss was 523 mL (range, 200 to 900), and surgery time was 111.9 minutes (range, 70.8 to 169.2), compared to 643 mL (range, 200 to 1,500) and 121.2 minutes (range, 75 to 259.8) for inpatients. There were two outpatients and three inpatients who returned to the emergency department within seven days. At 90 days, both groups had one readmission: a patient who had a wound dehiscence requiring irrigation and debridement and a patient who had an inferior epigastric bleed requiring embolization in outpatient and inpatient groups, respectively.
Early experience with SDD PAOs shows comparable safety to inpatient PAOs. Optimizing patient education and perioperative management will help facilitate outpatient PAO programs in other centers.
由于手术室准入和医院床位等卫生系统资源限制，髋关节发育不良的年轻患者及时获得治疗可能具有挑战性。本研究评估了同日出院（SDD）髋臼周围截骨术（PAO）的安全性和有效性。
连续有59例患者（平均年龄30岁；范围17至50岁；60%为女性）计划进行SDD。根据年龄和体重指数（BMI）将47例门诊患者与47例住院患者进行匹配。门诊患者的平均年龄为28岁（范围17至46岁），BMI为25.6（范围18.9至37.1），而2015年至2020年的住院患者平均年龄为28岁（范围16至44岁；BMI 25.9，范围19.4至34.7）。所有患者均接受全身麻醉及多模式疼痛管理。门诊组中46.8%的患者进行了辅助手术，住院组为34.0%。观察指标包括急诊复诊、再入院及不良事件（采用改良的Sink Dindo分类法）。
有6例门诊患者（12.8%）住院时间超过24小时，其中3例为计划内，3例未能同日出院，平均住院时间为10.1小时（范围5.7至23.8小时）。住院患者的平均住院时间为3.03天（范围1.03至11.8天）。未匹配的患者均未进行SDD。门诊患者平均失血量为523 mL（范围200至900 mL），手术时间为111.9分钟（范围70.8至169.2分钟），住院患者分别为643 mL（范围200至1500 mL）和121.2分钟（范围75至259.8分钟）。有2例门诊患者和3例住院患者在7天内返回急诊室。在90天时，两组各有1例再入院：门诊组1例患者伤口裂开需要冲洗和清创，住院组1例患者腹壁下出血需要栓塞。
SDD PAO的早期经验显示与住院PAO具有相当的安全性。优化患者教育和围手术期管理将有助于在其他中心开展门诊PAO项目。
