1、Same-Day Discharge in Total Joint Arthroplasty,May,2018,2016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。,The demand for TJA is increasingFast-track TJA:LOS 3 daysOutpatient:discharged on same day postoperative(less than 12-hour stay)Financial analysisOutpatient TJA would save$300 million annually,Introdu
2、ction,第二页，共三十二页。,Introduction,Safety is primary factor to be concernedComplication,mortality,readmission and reoperationRisk factor and patient selectionGeneral condition:age,gender,BMIHistorical or current disease:diabetes,cardiac disease,pulmonary disease,renal diseaseSurgical procedureGeneral or
3、regional or spinal anesthesia Standard or mini incisionTourniquet,drainagePerioperative management and discharge Postoperative function and rehabilitation,第三页，共三十二页。,Article#1,2017.JBJSLevel of Evidence Level III Retrospective study,第四页，共三十二页。,Article#1,Aim:to compare matched cohorts of patients who
4、 underwent same-day and inpatient hip or knee arthroplasty in terms of postoperative complications and 30-day readmission rates Design:retrospective matched cohorts studyData source:ACS-NSQIP registry from 517 US hospital from 2005-2014Outcomes:complications,readmission rates General character:177,8
5、18 patients,1,236 outpatients,176,582 inpatients,第五页，共三十二页。,Demographics,第六页，共三十二页。,Adverse events,第七页，共三十二页。,Adverse events in THA,第八页，共三十二页。,Adverse events in TKA,第九页，共三十二页。,Adverse events in UKA,第十页，共三十二页。,Risk factor of complication,第十一页，共三十二页。,Conclusion,No significant differences in overall po
6、stoperative 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。,Limitations,Retrospective studyThe function was not assessed Risk Factors for Complications and readmission should be given more detail
7、s,第十三页，共三十二页。,Article#2,2017.JOALevel of Evidence Level III Retrospective study,第十四页，共三十二页。,Article#2,Aim:To compare the predictive ability of the risk assessment of“Outpatient Arthroplasty Risk Assessment Score(OARA)”,“ASA”,“Charlson comorbidity index(CCI)”Design:retrospective studyOutcomes:sensiti
8、vity of the scalesGeneral character:1120 consecutive THA and TKA patientsMean Age 62.3 yrsMean BMI 32.4521 knees(53.2%)/458 hips(46.8%),第十五页，共三十二页。,OARA score,Indiana university 9 comorbidity areas Low risk:OARA 59High risk:OARA 60,第十六页，共三十二页。,OARA score,J Arthroplasty.2017 Aug;32(8):2325-2331,第十七页，
9、共三十二页。,Three scales,第十八页，共三十二页。,Positive predictive value,OARA SCORE 59 discharge POD 0 or 1:81.6%ASA 2 discharge POD 0 or 1:56.4%CCI=0 discharge POD 0 or 1:70.3%,第十九页，共三十二页。,Conclusion,Current medical selection criteria for outpatientTJA,such as ASA,are crude OARA Score represents a more sensitive
10、medical risk stratification for outpatient TJA,第二十页，共三十二页。,Article#3,2017.CORRLevel of Evidence Level I Randomized study,第二十一页，共三十二页。,Article#3,Aim: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(in
11、patient)in THAsDesign:Multicenter,RCTsOutcomes:postoperative pain;perioperative complications;readmissionGeneral 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。,Inclusion and exclusion criteria,初次单侧THABMI10g/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。,Periope
12、rative management,Direct anterior approach Spinal anesthesia24 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。,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(pngwn)无晕眩或呕吐良好的家庭照顾,第二十五页，共三十二页。,Demographics,General character:220 patients,M/F 117/103,age 60
13、.0 8.7 y,BMI 27.9 4.4 kg/m2No difference noted between the groups,第二十六页，共三十二页。,Results,Only VAS POD1 noted a significant difference between the group,第二十七页，共三十二页。,Conclusion,Outpatient THA can be comparable with inpatient with a strict inclusion and discharge criteria,第二十八页，共三十二页。,Limitations,Only 2
14、20 THAs were evaluatedThe applications of blood management,drainage and rehabilitation were not givenThe cost of patients was not evaluated,第二十九页，共三十二页。,Take home message,Outpatients TJA were comparable with inpatient in selected surgery in safety and complicationsOutpatients TJA can reduce the LOS
15、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,第三十页，共三十二页。,Thanks for your attention！,第三十一页，共三十二页。,内容(nirng)总结,Same-Day Discharge in Total。177,818 patients,1,236 outpatients,176,582 inpatients。1.06-5.40。non-insulin-dependent diabetes。Limitations。Design:Multicenter,RCTs。Outcomes:postoperative pain。2.4 2.2,第三十二页，共三十二页。,
