Jonathan M R French, Amy Woods, Adrian Sayers, Kevin Deere, Michael R Whitehouse
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The studies were predominantly from the USA and Canada, observational, and with a high risk of bias. Day-case patients were a mean of 2.08 years younger (95% CI 1.05 to 3.12), were more likely to be male (odds ratio (OR) 1.3 (95% CI 1.19 to 1.41)), and had a lower mean BMI and American Society of Anesthesiologists grades compared with inpatients. Overall, day-case surgery was associated with significantly lower odds of readmission (OR 0.83 (95% CI 0.73 to 0.96); p = 0.009), subsequent emergency department attendance (OR 0.62 (95% CI 0.48 to 0.79); p < 0.001), and complications (OR 0.7 (95% CI 0.55 to 0.89) p = 0.004), than inpatient surgery. There were no significant differences in the rates of reoperation or mortality. The overall rate of successful same-day discharge for day-case surgery was 85% (95% CI 81 to 88). Patient-reported outcome measures and cost-effectiveness were either equal or favoured day-case.</p><p><strong>Conclusion: </strong>Within the limitations of the literature, in particular the substantial risk of selection bias, the outcomes following day-case knee and hip replacement appear not to be inferior to those following an inpatient stay. The evidence is more robust for unicompartmental knee replacement (UKR) than for total knee replacement (TKR) or total hip replacement (THR). 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引用次数: 0
摘要
目的：在过去二十年中，特别是自COVID-19大流行以来，患者在手术当天出院的单日膝关节和髋关节置换术越来越受欢迎。本系统综述介绍了比较日间病例和住院手术的证据。方法：对MEDLINE、Embase和灰色文献数据库进行系统的文献检索，包括所有比较日间病例和住院患者膝关节和髋关节置换术的研究。在适当的地方使用随机效应模型进行meta分析。该方案进行前瞻性注册（PROSPERO CRD42023392811）。结果：共纳入38项研究，共83888例日病例。这些研究主要来自美国和加拿大，是观察性的，有很高的偏倚风险。日间病例患者平均年轻2.08岁（95% CI 1.05 - 3.12），男性更有可能（优势比（OR） 1.3 (95% CI 1.19 - 1.41)），与住院患者相比，平均BMI和美国麻醉医师学会评分较低。总体而言，日间手术与再入院几率显著降低相关(OR 0.83 (95% CI 0.73 - 0.96)；p = 0.009)，随后的急诊出勤率(OR 0.62 (95% CI 0.48 ~ 0.79)；p < 0.001)，并发症发生率（OR 0.7 (95% CI 0.55 ~ 0.89) p = 0.004）高于住院手术。两组再手术率和死亡率无显著差异。当日手术的总成功出院率为85% （95% CI 81 ~ 88）。患者报告的结果测量和成本效益相等或偏向日间病例。结论：在文献的限制下，特别是在选择偏倚的重大风险下，当日病例膝关节和髋关节置换术的结果似乎并不逊于住院患者。单室膝关节置换术（UKR）的证据比全膝关节置换术（TKR）或全髋关节置换术（THR）更有力。当天成功排放的比率在UKR最高，其次是TKR，而在THR相对较低。
Aims: Day-case knee and hip replacement, in which patients are discharged on the day of surgery, has been gaining popularity during the last two decades, and particularly since the COVID-19 pandemic. This systematic review presents the evidence comparing day-case to inpatient-stay surgery.
Methods: A systematic literature search was performed of MEDLINE, Embase, and grey literature databases to include all studies which compare day-case with inpatient knee and hip replacement. Meta-analyses were performed where appropriate using a random effects model. The protocol was registered prospectively (PROSPERO CRD42023392811).
Results: A total of 38 studies were included, with a total of 83,888 day-case procedures. The studies were predominantly from the USA and Canada, observational, and with a high risk of bias. Day-case patients were a mean of 2.08 years younger (95% CI 1.05 to 3.12), were more likely to be male (odds ratio (OR) 1.3 (95% CI 1.19 to 1.41)), and had a lower mean BMI and American Society of Anesthesiologists grades compared with inpatients. Overall, day-case surgery was associated with significantly lower odds of readmission (OR 0.83 (95% CI 0.73 to 0.96); p = 0.009), subsequent emergency department attendance (OR 0.62 (95% CI 0.48 to 0.79); p < 0.001), and complications (OR 0.7 (95% CI 0.55 to 0.89) p = 0.004), than inpatient surgery. There were no significant differences in the rates of reoperation or mortality. The overall rate of successful same-day discharge for day-case surgery was 85% (95% CI 81 to 88). Patient-reported outcome measures and cost-effectiveness were either equal or favoured day-case.
Conclusion: Within the limitations of the literature, in particular the substantial risk of selection bias, the outcomes following day-case knee and hip replacement appear not to be inferior to those following an inpatient stay. The evidence is more robust for unicompartmental knee replacement (UKR) than for total knee replacement (TKR) or total hip replacement (THR). The rate of successful same-day discharge is highest in UKR, followed by TKR and comparatively lower in THR.
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