Same-day discharge to home is feasible and safe in up to 75% of unselected total hip and knee arthroplasty

被引:17
作者
Verdier, Nicolas [1 ,2 ]
Boutaud, Benoit [1 ,2 ]
Ragot, Patrick [3 ]
Leroy, Pierre [1 ]
Saffarini, Mo [4 ]
Nover, Luca [4 ]
Magendie, Jerome [1 ,2 ]
机构
[1] Polyclin Jean Villar, ELSAN, 56 Av Maryse Bastie, F-33520 Brugge, France
[2] Clin Hanche & Genou, 2 Ave Terreft, F-33520 Brugge, France
[3] InfoMed Dept, ELSAN, 58 Bis Rue Boetie, F-75008 Paris, France
[4] ReSurg SA, Rue St Jean 22, CH-1260 Nyon, Switzerland
关键词
Same-day discharge; Ambulatory total joint arthroplasty; Total hip arthroplasty; Total knee arthroplasty; Patient education; INTRAVENOUS GENERAL-ANESTHESIA; SPINAL-ANESTHESIA; RECOVERY;
D O I
10.1007/s00264-022-05348-7
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose Though numerous studies highlighted benefits of ambulatory total joint arthroplasty (TJA), most had selected patients with age and comorbidities thresholds. We aimed to report proportions of unselected TJAs that could be scheduled for and operated in ambulatory settings, and to determine factors that hinder same-day discharge (SDD). Methods We studied 1100 consecutive primary TJAs (644 THAs and 456 TKAs) that were prepared following a multidisciplinary protocol for patient education and logistical preparation. Data were stratified for THA vs TKA and for success vs failure of SDD to home and multivariable analysis was performed to determine factors associated with failure of scheduled SDD to home. Results In total, 860 (78.2%) were scheduled for ambulatory surgery, but only 819 (74.5%) achieved SDD to home; 240 (21.8%) were scheduled for non-ambulatory surgery, but 103 (9.3%) achieved SDD to rehabilitation centre. Re-operations were required in 9 (1.0%) ambulatory TJAs vs 2 (0.8%) non-ambulatory TJAs (p = 0.769), while revisions were required in 13 (1.5%) ambulatory TJAs vs 1 (0.4%) non-ambulatory TJAs (p = 0.181). Multivariable analysis confirmed that failure of SDD to home was greater for women (OR 2.59; p = 0.011) and THA (vs TKA, OR 2.41; p = 0.023). Conclusion With appropriate education and preparation, 75% of unselected primary hip and knee arthroplasties achieved SDD to home without compromising risks of complications, re-operations, or revisions. A further 9% achieved SDD to rehabilitation centre, implying that 84% of patients did not require overnight stay. These findings suggest that ambulatory surgery is feasible and safe to implement in most unselected lower limb arthroplasties.
引用
收藏
页码:1019 / 1027
页数:9
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