日间手术在髋膝关节置换的应用1-四川大学华西医院PPT推荐.pptx

日间手术在髋膝关节置换的应用1-四川大学华西医院PPT推荐.pptx

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LOS3daysOutpatient:

dischargedonsamedaypostoperative（lessthan12-hourstay）FinancialanalysisOutpatientTJAwouldsave$300millionannually,Introduction,Introduction,SafetyisprimaryfactortobeconcernedComplication,mortality,readmissionandreoperationRiskfactorandpatientselectionGeneralcondition:

age,gender,BMIHistoricalorcurrentdisease:

diabetes,cardiacdisease,pulmonarydisease,renaldiseaseSurgicalprocedureGeneralorregionalorspinalanesthesiaStandardorminiincisionTourniquet,drainagePerioperativemanagementanddischargePostoperativefunctionandrehabilitation,Article#1,2017.JBJSLevelofEvidenceLevelIIIRetrospectivestudy,Article#1,Aim:

tocomparematchedcohortsofpatientswhounderwentsame-dayandinpatienthiporkneearthroplastyintermsofpostoperativecomplicationsand30-dayreadmissionratesDesign:

retrospectivematchedcohortsstudyDatasource:

ACS-NSQIPregistryfrom517UShospitalfrom2005-2014Outcomes:

complications,readmissionratesGeneralcharacter:

177,818patients,1,236outpatients,176,582inpatients,Demographics,Adverseevents,AdverseeventsinTHA,AdverseeventsinTKA,AdverseeventsinUKA,Riskfactorofcomplication,Conclusion,Nosignificantdifferencesinoverallpostoperativecomplicationsorreadmissionwerefoundbetweenmatchedcohortsofpatientswhounderwentsame-dayandinpatienthipandkneearthroplasties,Limitations,RetrospectivestudyThefunctionwasnotassessedRiskFactorsforComplicationsandreadmissionshouldbegivenmoredetails,Article#2,2017.JOALevelofEvidenceLevelIIIRetrospectivestudy,Article#2,Aim:

Tocomparethepredictiveabilityoftheriskassessmentof“OutpatientArthroplastyRiskAssessmentScore（OARA）”,“ASA”,“Charlsoncomorbidityindex（CCI）”Design:

retrospectivestudyOutcomes:

sensitivityofthescalesGeneralcharacter:

1120consecutiveTHAandTKApatientsMeanAge62.3yrsMeanBMI32.4521knees（53.2%）/458hips（46.8%）,OARAscore,Indianauniversity9comorbidityareasLowrisk:

OARA59Highrisk:

OARA60,OARAscore,JArthroplasty.2017Aug;

32（8）:

2325-2331,Threescales,Positivepredictivevalue,OARASCORE59dischargePOD0or1:

81.6%ASA2dischargePOD0or1:

56.4%CCI=0dischargePOD0or1:

70.3%,Conclusion,CurrentmedicalselectioncriteriaforoutpatientTJA,suchasASA,arecrudeOARAScorerepresentsamoresensitivemedicalriskstratificationforoutpatientTJA,Article#3,2017.CORRLevelofEvidenceLevelIRandomizedstudy,Article#3,Aim:

Tocomparedischargedonthesamedayasthesurgery（outpatient,lessthan12-hourstay）withthosewhoaredischargedafteranovernighthospitalstay（inpatient）inTHAsDesign:

Multicenter,RCTsOutcomes:

postoperativepain;

perioperativecomplications;

readmissionGeneralcharacter:

220patients,M/F117/103,age60.08.7y,BMI27.94.4kg/m2,Inclusionandexclusioncriteria,初次单侧THABMI10g/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,Perioperativemanagement,DirectanteriorapproachSpinalanesthesia24hoursofantibiotic,曲马多,酮咯酸,普瑞巴林,塞来昔布,氢化可的松,磺胺过敏,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无晕眩或呕吐良好的家庭照顾,Demographics,Generalcharacter:

220patients,M/F117/103,age60.08.7y,BMI27.94.4kg/m2Nodifferencenotedbetweenthegroups,Results,OnlyVASPOD1notedasignificantdifferencebetweenthegroup,Conclusion,OutpatientTHAcanbecomparablewithinpatientwithastrictinclusionanddischargecriteria,Limitations,Only220THAswereevaluatedTheapplicationsofbloodmanagement,drainageandrehabilitationwerenotgivenThecostofpatientswasnotevaluated,Takehomemessage,OutpatientsTJAwerecomparablewithinpatientinselectedsurgeryinsafetyandcomplicationsOutpatientsTJAcanreducetheLOSandwerecostsavingOutpatientArthroplastyRiskAssessment（OARA）scorewasneededinriskstratificationAstrictdischargecriteriashouldbemeetbeforedischargeRehabilitationandfunctionshouldbeassessedinfutureresearchPerioperativemanagement,surgicalandanesthesiatechnologyshouldbeoptimal,Thanksforyourattention！