日间手术在髋膝关节置换的应用

Same-DayDischargeinTotalJointArthroplastyMay,

20182016级硕士(shuòshì)研究生：罗泽宇研究生导师：周宗科教授第一页，共三十二页。整理课件ThedemandforTJAisincreasingFast-trackTJA:LOS<3daysOutpatient:dischargedonsamedaypostoperative(lessthan12-hourstay)FinancialanalysisOutpatientTJAwouldsave$300millionannuallyIntroduction第二页，共三十二页。整理课件IntroductionSafetyisprimaryfactortobeconcernedComplication,

mortality,readmissionandreoperationRiskfactorandpatientselectionGeneralcondition:age,gender,BMIHistoricalorcurrentdisease:diabetes,cardiacdisease,pulmonarydisease,renaldiseaseSurgicalprocedureGeneralorregionalorspinalanesthesiaStandardorminiincisionTourniquet,drainagePerioperativemanagementanddischargePostoperativefunction

andrehabilitation第三页，共三十二页。整理课件Article#12017.JBJSLevelofEvidenceLevelIIIRetrospectivestudy第四页，共三十二页。整理课件Article#1Aim:tocomparematchedcohortsofpatientswhounderwentsame-dayandinpatienthiporkneearthroplastyintermsofpostoperativecomplicationsand30-dayreadmissionratesDesign:retrospectivematchedcohortsstudyDatasource:ACS-NSQIPregistryfrom517UShospitalfrom2005-2014Outcomes:complications,readmissionratesGeneralcharacter:177,818

patients,

1,236

outpatients,176,582inpatients第五页，共三十二页。整理课件Demographics第六页，共三十二页。整理课件Adverseevents第七页，共三十二页。整理课件AdverseeventsinTHA第八页，共三十二页。整理课件AdverseeventsinTKA第九页，共三十二页。整理课件AdverseeventsinUKA第十页，共三十二页。整理课件RiskfactorofcomplicationFactorsRelativerisk95%confidenceinterval(CI)PvalueBMI>35kg/m22.39

1.06-5.400.035insulin-dependentdiabetes4.021.06-15.300.041non-insulin-dependentdiabetes3.271.29-8.340.013Age>855.361.09-23.330.039第十一页，共三十二页。整理课件ConclusionNosignificantdifferencesinoverallpostoperativecomplicationsorreadmissionwerefoundbetweenmatchedcohortsofpatientswhounderwentsame-dayandinpatienthipandkneearthroplasties

第十二页，共三十二页。整理课件LimitationsRetrospectivestudyThefunctionwasnotassessedRiskFactorsforComplicationsandreadmissionshouldbegivenmoredetails

第十三页，共三十二页。整理课件Article#22017.JOALevelofEvidenceLevelIIIRetrospectivestudy第十四页，共三十二页。整理课件Article#2Aim:Tocomparethepredictiveabilityoftheriskassessmentof“OutpatientArthroplastyRiskAssessmentScore(OARA)”,“ASA”,“Charlsoncomorbidityindex(CCI)”Design:retrospectivestudyOutcomes:sensitivityofthescalesGeneralcharacter:1120consecutiveTHAandTKApatientsMeanAge62.3yrsMeanBMI32.4521knees(53.2%)/458hips(46.8%)

第十五页，共三十二页。整理课件OARAscoreIndianauniversity9comorbidityareasLowrisk:OARA≤59Highrisk:OARA≥60

第十六页，共三十二页。整理课件OARAscoreJArthroplasty.2017Aug;32(8):2325-2331第十七页，共三十二页。整理课件Threescales第十八页，共三十二页。整理课件PositivepredictivevalueOARASCORE≤59dischargePOD0or1:

81.6%ASA≤2dischargePOD0or1:

56.4%CCI=0dischargePOD0or1:

70.3%

第十九页，共三十二页。整理课件ConclusionCurrentmedicalselectioncriteriaforoutpatient

TJA,suchasASA,arecrude

OARAScorerepresentsamoresensitivemedicalriskstratificationforoutpatientTJA

第二十页，共三十二页。整理课件Article#32017.CORRLevelofEvidenceLevelIRandomizedstudy第二十一页，共三十二页。整理课件Article#3Aim:Tocomparedischargedonthesamedayasthesurgery(‘‘outpatient,’’lessthan12-hourstay)withthosewhoaredischargedafteranovernighthospitalstay(‘‘inpatient’’)inTHAsDesign:Multicenter,RCTsOutcomes:postoperativepain;perioperativecomplications;readmissionGeneralcharacter:220patients,M/F117/103,age60.0±8.7y,BMI27.9±4.4kg/m2第二十二页，共三十二页。整理课件Inclusionandexclusioncriteria初次单侧THABMI<40Age<75HB>10g/dL无心肺疾病术前不需轮椅术前不长期鸦片(yāpiàn)镇痛术后回家有良好照看第二十三页，共三十二页。整理课件PerioperativemanagementDirectanteriorapproachSpinalanesthesia24hoursofantibiotic

曲马多酮咯酸普瑞巴林(bālín)塞来昔布氢化可的松磺胺(huánɡàn)过敏第二十四页，共三十二页。整理课件Dischargecriteria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(píngwěn)无晕眩或呕吐良好的家庭照顾

第二十五页，共三十二页。整理课件DemographicsGeneralcharacter:220patients,M/F117/103,age60.0±8.7y,BMI27.9±4.4kg/m2Nodifferencenotedbetweenthegroups第二十六页，共三十二页。整理课件ResultsOutpatientInpatientPvalueVASPON12.8±2.53.3±2.30.12

VASPOD13.7±2.32.8±2.1

0.01VASPOW41.7±1.9

1.7±1.9

0.77HHSPOW475±1875±140.77Reoperation211Readmissions140.21Contactstostaff2.4±1.9

2.4±2.2

0.94OnlyVASPOD1notedasignificantdifferencebetweenthegroup第二十七页，共三十二页。整理课件ConclusionOutpatientTHAcanbecomparablewithinpatientwithastrictinclusionanddischargecriteria

第二十八页，共三十二页。整理课件LimitationsOnly220THAswereevaluatedTheapplicationsofbloodmanagement,drainageandrehabilitationwerenotgivenThecostofpatientswasnotevaluated第二十九页，共三十二页。整理课件TakehomemessageOutpatientsTJAwerecomparablewithinpatientinselectedsurgeryinsafetyandcomplicationsOutpatientsTJAcanreducetheLOSandwerecostsavingOutpatientArthroplastyRiskAssessment(OARA)scorewasneededinriskstratificationAstrictdischargecriteriashouldbemeetbeforedischargeRehabilitationandfunctionshouldbeassessedinfutureresearchPerioperativemanagement,surgicalandanesthesiatechnologyshouldbeoptimal第三十页，共三十二页。整理