日间手术在髋膝关节置换的应用1四川大学华西医院课件.ppt

1、Same-Day Discharge in Total Joint ArthroplastyMay,20182016级硕士研究生：罗泽宇研究生导师：周宗科教授?The demand for TJA is increasing?Fast-track TJA:LOS 35kg/m22.391.06-5.400.035insulin-dependent diabetes4.021.06-15.300.041non-insulin-dependent diabetes3.271.29-8.340.013Age855.361.09-23.330.039Conclusion?No significant

2、differences in overall postoperative complications or readmission were found between matched cohorts of patients who underwent same-day and inpatient hip and knee arthroplastiesLimitations?Retrospective study?The function was not assessed?Risk Factors for Complications and readmission should be give

3、n more detailsArticle#22017.JOALevel of Evidence Level III Retrospective study Article#2?Aim:To compare the predictive ability of the risk assessment of“Outpatient Arthroplasty Risk Assessment Score(OARA)”,“ASA”,“Charlson comorbidity index(CCI)”?Design:retrospective study?Outcomes:sensitivity of the

4、 scales?General character:?1120 consecutive THA and TKA patients?Mean Age 62.3 yrs?Mean BMI 32.4?521 knees(53.2%)/458 hips(46.8%)OARA score?Indiana university?9 comorbidity areas?Low risk:OARA 59?High risk:OARA 60OARA score J Arthroplasty.2017 Aug;32(8):2325-2331Three scalesPositive predictive value

5、?OARA SCORE 59 discharge POD 0 or 1:81.6%?ASA 2 discharge POD 0 or 1:56.4%?CCI=0 discharge POD 0 or 1:70.3%Conclusion?Current medical selection criteria for outpatientTJA,such as ASA,are crude?OARA Score represents a more sensitive medical risk stratification for outpatient TJAArticle#32017.CORRLeve

6、l of Evidence Level I Randomized study Article#3?Aim:To compare discharged on the same day as the surgery(outpatient,less than 12-hour stay)with those who are discharged after an overnight hospital stay(inpatient)in THAs?Design:Multicenter,RCTs?Outcomes:postoperative pain;perioperative complications

7、;readmission?General character:220 patients,M/F 117/103,age 60.0 8.7 y,BMI 27.9 4.4 kg/m2Inclusion and exclusion criteria?初次单侧THA?BMI40?Age10g/dL?无心肺疾病?术前不需轮椅?术前不长期鸦片镇痛?术后回家有良好照看Perioperative management?Direct anterior approach?Spinal anesthesia?24 hours of antibiotic 曲马多酮咯酸普瑞巴林塞来昔布氢化可的松磺胺过敏Discharg

8、e criteria?走80英尺?上下楼?知晓家庭康复?上厕所?独立起床?独立日常活动?术后小便?固体食物?疼痛控制良好?生命体征平稳?无晕眩或呕吐?良好的家庭照顾Demographics?General character:?220 patients,M/F 117/103,age 60.0 8.7 y,BMI 27.9 4.4 kg/m2?No difference noted between the groupsResultsOutpatientInpatient P valueVAS PON12.8 2.53.3 2.30.12VAS POD13.7 2.32.8 2.10.01VAS

9、 POW41.7 1.91.7 1.90.77HHS POW475 1875 140.77Reoperation 211Readmissions 140.21Contacts to staff2.4 1.92.4 2.20.94?Only VAS POD1 noted a significant difference between the groupConclusion?Outpatient THA can be comparable with inpatient with a strict inclusion and discharge criteria Limitations?Only

10、220 THAs were evaluated?The applications of blood management,drainage and rehabilitation were not given?The cost of patients was not evaluatedTake home message?Outpatients TJA were comparable with inpatient in selected surgery in safety and complications?Outpatients TJA can reduce the LOS and were c

11、ost saving?Outpatient Arthroplasty Risk Assessment(OARA)score was needed in risk stratification?A strict discharge criteria should be meet before discharge?Rehabilitation and function should be assessed in future research?Perioperative management,surgical and anesthesia technology should be optimal Thanks for your attention！