日间手术在髋膝关节置换的应用四川大学华西医院.pptx

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1、The demand for TJA is increasingFast-track TJA:LOS 35kg/m22.39 1.06-5.400.035insulin-dependent diabetes4.021.06-15.300.041non-insulin-dependent diabetes3.271.29-8.340.013Age855.361.09-23.330.039第10页/共31页Conclusion No significant differences in overall postoperative complications or readmission were

2、found between matched cohorts of patients who underwent same-day and inpatient hip and knee arthroplasties第11页/共31页LimitationsRetrospective studyThe function was not assessed Risk Factors for Complications and readmission should be given more details第12页/共31页Article#22017.JOALevel of Evidence Level

3、III Retrospective study 第13页/共31页Article#2Aim:To compare the predictive ability of the risk assessment of“Outpatient Arthroplasty Risk Assessment Score(OARA)”,“ASA”,“Charlson comorbidity index(CCI)”Design:retrospective studyOutcomes:sensitivity of the scalesGeneral character:1120 consecutive THA and

4、 TKA patientsMean Age 62.3 yrsMean BMI 32.4521 knees(53.2%)/458 hips(46.8%)第14页/共31页OARA score Indiana university 9 comorbidity areas Low risk:OARA 59High risk:OARA 60第15页/共31页OARA score J Arthroplasty.2017 Aug;32(8):2325-2331第16页/共31页Three scales第17页/共31页Positive predictive value pOARA SCORE 59 dis

5、charge 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18页/共31页Conclusion pCurrent medical selection criteria for outpatientTJA,such as ASA,are crude pOARA Score represents a more sensitive medical risk stratification for outpatient TJA第19页/共31页Article#32017.CORRLe

6、vel of Evidence Level I Randomized study 第20页/共31页Article#3Aim: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 THAsDesign:Multicenter,RCTsOutcomes:postoperative pain;perioperative compl

7、ications;readmissionGeneral character:220 patients,M/F 117/103,age 60.0 8.7 y,BMI 27.9 4.4 kg/m2第21页/共31页Inclusion 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第22页/共31页Perioperative management Direct anterior approach Spinal anesthesia24 hours of antibiotic 曲马多酮咯酸普瑞巴林塞来昔布

8、氢化可的松磺胺过敏第23页/共31页Discharge 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第24页/共31页Demographics General character:220 patients,M/F 117/103,age 60.0 8.7 y,BMI 27.9 4.4 kg/m2No difference noted between the groups第25页/共31页ResultsOutpatientInpatient P valueVAS PON12.8 2.53.3 2.30.

9、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 0.94Only VAS POD1 noted a significant difference between the group第26页/共31页Conclusion Outpatient THA can be comparable with inpatient with a strict inclu

10、sion and discharge criteria 第27页/共31页LimitationsOnly 220 THAs were evaluatedThe applications of blood management,drainage and rehabilitation were not givenThe cost of patients was not evaluated第28页/共31页Take home message Outpatients TJA were comparable with inpatient in selected surgery in safety and

11、 complicationsOutpatients TJA can reduce the LOS and were cost savingOutpatient Arthroplasty Risk Assessment(OARA)score was needed in risk stratification A strict discharge criteria should be meet before dischargeRehabilitation and function should be assessed in future researchPerioperative management,surgical and anesthesia technology should be optimal 第29页/共31页Thanks for your attention！第30页/共31页感谢您的观看！第31页/共31页