Efficacy and Safety of a Patient Selection Tool for Predicted Discharge at an Ambulatory Surgical Center: A Pilot Study

IF 1.5 Q3 ORTHOPEDICS
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引用次数: 0

Abstract

Background

There is a paucity of validated risk stratification tools to assess which patients can safely and predictably undergo outpatient total hip (THA) or knee arthroplasty (TKA) in an ambulatory surgery center (ASC).

Methods

Our novel patient selection tool was prospectively applied to 190 consecutive primary THA and TKA performed by a single surgeon at a single ASC. We identified the proportion of patients discharged home the same day, those requiring a one-night stay, or those with failed discharge within 23 hours. A retrospective chart review was performed to determine if any demographic parameters were risk factors for an overnight stay.

Results

Overall, 190 (100%) patients selected for outpatient THA and TKA were discharged home within 23 hours. One hundred and four patients (55%) were discharged the same day of surgery, whereas 86 (45%) required overnight stay and were discharged on postoperative day 1. Female sex (odds ratio [OR]: 4.1, 95% confidence interval [CI]: 2.0-8.2, P < .001), THA (OR: 2.5, 95% CI: 1.1-5.5, P = .022), and heavier body mass index (OR: 1.0, 95% CI: 1.0-1.2, P = .022) were identified as independent risk factors for staying overnight in the ASC.

Conclusions

In this pilot study, we found that 100% of outpatient THA and TKA-eligible patients were able to be discharged home by postoperative day 1. Additionally, we found that this selection tool is safe and effective at predicting short-stay discharge in an ASC.

门诊手术中心预测出院患者选择工具的有效性和安全性:试点研究
背景目前还缺乏经过验证的风险分层工具来评估哪些患者可以在非卧床手术中心(ASC)安全、可预测地接受门诊全髋(THA)或膝关节置换术(TKA)。方法我们的新型患者选择工具被前瞻性地应用于由一名外科医生在一家非卧床手术中心连续实施的 190 例初级全髋(THA)和全膝(TKA)手术。我们确定了当天出院回家的患者比例、需要住院一晚的患者比例或23小时内出院失败的患者比例。我们对病历进行了回顾性分析,以确定是否有任何人口统计学参数是导致患者过夜的风险因素。结果总体而言,190 名(100%)被选中接受门诊 THA 和 TKA 的患者在 23 小时内出院回家。144名患者(55%)在手术当天出院,86名患者(45%)需要过夜,并在术后第1天出院。女性性别(几率比 [OR]:4.1,95% 置信区间 [CI]:2.0-8.2,P = .001)、THA(OR:2.5,95% CI:1.1-5.5,P = .022)和体重指数较重(OR:1.0,95% CI:1.0-1.2,P = .022)被确定为独立风险因素。结论在这项试点研究中,我们发现 100%符合 THA 和 TKA 手术条件的门诊患者都能在术后第 1 天出院回家。此外,我们还发现这种选择工具在预测短期出院 ASC 方面既安全又有效。
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来源期刊
Arthroplasty Today
Arthroplasty Today Medicine-Surgery
CiteScore
2.90
自引率
0.00%
发文量
258
审稿时长
40 weeks
期刊介绍: Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.
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