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

1、Same-Day Discharge in Total Joint ArthroplastyMay, 20182016级硕士(shush)研究生：罗泽宇研究生导师：周宗科教授第一页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院pThe demand for TJA is increasingpFast-track TJA: LOS 35kg/m22.39 1.06 - 5.400.035insulin-dependent diabetes4.021.06-15.300.041non-insulin-dependent diabetes3.271.29-8.340.013Age8

2、55.361.09-23.330.039第十一页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Conclusion pNo significant differences in overall postoperative complications or readmission were found between matched cohorts of patients who underwent same-day and inpatient hip and knee arthroplasties第十二页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Limita

3、tionspRetrospective studypThe function was not assessed pRisk Factors for Complications and readmission should be given more details第十三页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Article #22017 . JOALevel of Evidence Level III Retrospective study 第十四页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Article #2pAim: To compare the

4、 predictive ability of the risk assessment of “Outpatient Arthroplasty Risk Assessment Score (OARA)” ,“ASA”, “Charlson comorbidity index (CCI)”pDesign: retrospective studypOutcomes: sensitivity of the scalespGeneral character: 1120 consecutive THA and TKA patients Mean Age 62.3 yrs Mean BMI 32.4 521

5、 knees (53.2%) / 458 hips (46.8%)第十五页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院OARA score pIndiana university p9 comorbidity areas pLow risk: OARA 59pHigh risk: OARA 60第十六页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院OARA score J Arthroplasty. 2017 Aug;32(8):2325-2331第十七页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Three scales第十八页，共三十二页

6、。日间手术在髋膝关节置换的应用1-四川大学华西医院Positive predictive value pOARA SCORE 59 discharge POD 0 or 1: 81.6%pASA 2 discharge POD 0 or 1: 56.4%pCCI=0 discharge POD 0 or 1: 70.3%第十九页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Conclusion pCurrent medical selection criteria for outpatientTJA, such as ASA, are crude pOARA Score rep

7、resents a more sensitive medical risk stratification for outpatient TJA第二十页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Article #32017 . CORRLevel of Evidence Level I Randomized study 第二十一页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Article #3pAim: To compare discharged on the same day as the surgery (outpatient, less than 12

8、-hour stay)with those who are discharged after an overnight hospital stay (inpatient) in THAspDesign: Multicenter, RCTspOutcomes: postoperative pain; perioperative complications; readmissionpGeneral character: 220 patients, M/F 117/103, age 60.0 8.7 y, BMI 27.9 4.4 kg/m2第二十二页，共三十二页。日间手术在髋膝关节置换的应用1-四

9、川大学华西医院Inclusion 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(ypin)镇痛 术后回家有良好照看第二十三页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Perioperative management pDirect anterior approach pSpinal anesthesiap24 hours of antibiotic 曲马多酮咯酸普瑞巴林(b ln)塞来昔布氢化可的松磺胺(hun n)过敏第二十四页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华

10、西医院Discharge criteria p 走80英尺p上下楼p知晓家庭康复p上厕所p独立起床p独立日常活动p 术后小便p固体食物p疼痛控制良好p生命体征平稳(pngwn)p无晕眩或呕吐p良好的家庭照顾第二十五页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Demographics pGeneral character: 220 patients, M/F 117/103, age 60.0 8.7 y, BMI 27.9 4.4 kg/m2pNo difference noted between the groups第二十六页，共三十二页。日间手术在髋膝关节置换的应用1-

11、四川大学华西医院ResultsOutpatientInpatient P valueVAS PON12.8 2.53.3 2.30.12 VAS POD13.7 2.32.8 2.1 0.01VAS POW41.7 1.9 1.7 1.9 0.77HHS POW475 1875 140.77Reoperation 211Readmissions 140.21Contacts to staff2.4 1.9 2.4 2.2 0.94pOnly VAS POD1 noted a significant difference between the group第二十七页，共三十二页。日间手术在髋膝关

12、节置换的应用1-四川大学华西医院Conclusion pOutpatient THA can be comparable with inpatient with a strict inclusion and discharge criteria 第二十八页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院LimitationspOnly 220 THAs were evaluatedpThe applications of blood management, drainage and rehabilitation were not givenpThe cost of patient

13、s was not evaluated第二十九页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院Take home message pOutpatients TJA were comparable with inpatient in selected surgery in safety and complicationspOutpatients TJA can reduce the LOS and were cost savingpOutpatient Arthroplasty Risk Assessment (OARA) score was needed in risk str

14、atification p A strict discharge criteria should be meet before dischargep Rehabilitation and function should be assessed in future researchpPerioperative management, surgical and anesthesia technology should be optimal 第三十页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院第三十一页，共三十二页。日间手术在髋膝关节置换的应用1-四川大学华西医院内容(nirng)总结Same-Day Dischar