日间手术在髋膝关节置换的应用1四川大学华西医院.pptx

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 diabetes3.271.29-8.340.013Age855.361.09-23.330.039Conclusion 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 arthroplastiesLimitationspRetrospective studypThe function was not assessed pRisk Factors for Complications and readmission should be given more detailsArticle#22017.JOALevel of Evidence Level III Retrospective study Article#2pAim:To compare the 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 patientsMean Age 62.3 yrsMean BMI 32.4521 knees(53.2%)/458 hips(46.8%)OARA score pIndiana university p9 comorbidity areas pLow risk:OARA 59pHigh risk:OARA 60OARA score J Arthroplasty.2017 Aug;32(8):2325-2331Three scalesPositive 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%Conclusion pCurrent medical selection criteria for outpatientTJA,such as ASA,are crude pOARA Score represents a more sensitive medical risk stratification for outpatient TJAArticle#32017.CORRLevel of Evidence Level I Randomized study Article#3pAim: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 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/m2Inclusion and exclusion criteria初次单侧THABMI40Age10g/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 pDirect anterior approach pSpinal anesthesiap24 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p无晕眩或呕吐p良好的家庭照顾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 groupsResultsOutpatientInpatient 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 groupConclusion pOutpatient THA can be comparable with inpatient with a strict inclusion and discharge criteria LimitationspOnly 220 THAs were evaluatedpThe applications of blood management,drainage and rehabilitation were not givenpThe cost of patients was not evaluatedTake 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 stratification pA strict discharge criteria should be meet before dischargepRehabilitation and function should be assessed in future researchpPerioperative management,surgical and anesthesia technology should be optimal Thanks for your attention！