齐鲁医学日间手术在髋膝关节置换的应用1-四川大学华西医院.pptx

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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12021/7/27 星期二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 diabetes3.271.29-8.340.013Age855.361.09-23.330.039112021/7/27

2、 星期二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 arthroplasties122021/7/27 星期二LimitationspRetrospective studypThe function was not assessed pRisk Factors f

3、or Complications and readmission should be given more details132021/7/27 星期二Article#22017.JOALevel of Evidence Level III Retrospective study 142021/7/27 星期二Article#2pAim:To compare the predictive ability of the risk assessment of“Outpatient Arthroplasty Risk Assessment Score(OARA)”,“ASA”,“Charlson c

4、omorbidity 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%)152021/7/27 星期二OARA score pIndiana university p9 comorbidity areas pLow risk:OARA 59pHigh risk:OAR

5、A 60162021/7/27 星期二OARA score J Arthroplasty.2017 Aug;32(8):2325-2331172021/7/27 星期二Three scales182021/7/27 星期二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%192021/7/27 星期二Conclusion pCurrent medical selection cri

6、teria for outpatientTJA,such as ASA,are crude pOARA Score represents a more sensitive medical risk stratification for outpatient TJA202021/7/27 星期二Article#32017.CORRLevel of Evidence Level I Randomized study 212021/7/27 星期二Article#3pAim:To compare discharged on the same day as the surgery(outpatient

7、,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/m2222021/7/27 星期二Inclusion an

8、d 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232021/7/27 星期二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242021/7/27 星期二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

9、良好的家庭照顾252021/7/27 星期二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 groups262021/7/27 星期二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 14

10、0.77Reoperation 211Readmissions 140.21Contacts to staff2.4 1.9 2.4 2.2 0.94pOnly VAS POD1 noted a significant difference between the group272021/7/27 星期二Conclusion pOutpatient THA can be comparable with inpatient with a strict inclusion and discharge criteria 282021/7/27 星期二LimitationspOnly 220 THAs

11、 were evaluatedpThe applications of blood management,drainage and rehabilitation were not givenpThe cost of patients was not evaluated292021/7/27 星期二Take home message pOutpatients TJA were comparable with inpatient in selected surgery in safety and complicationspOutpatients TJA can reduce the LOS an

12、d 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 302021/7/27 星期二Thanks for your attention！312021/7/27 星期二