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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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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Same-DayDischargeinTotalJointArthroplasty,May,2018,2016级硕士研究生:
罗泽宇研究生导师:
周宗科教授,ThedemandforTJAisincreasingFast-trackTJA:
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!
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- 日间 手术 膝关节 置换 应用 四川大学 华西 医院