摘要
导言：由于医疗系统的资源限制（如手术室和医院床位），及时为髋关节发育不良的年轻患者提供手术治疗具有挑战性。本研究评估了当天出院（SDD）髋臼周围截骨术（PAO）的安全性和有效性：共有 59 名连续患者（平均年龄 30 岁；年龄范围 17 至 50 岁；60% 为女性）计划接受 SDD。其中 47 名门诊患者与 47 名住院患者的年龄和体重指数（BMI）相匹配。门诊患者的平均年龄为 28 岁（范围在 17 至 46 岁之间），体重指数为 25.6（范围在 18.9 至 37.1 之间），而 2015 年至 2020 年期间的住院患者的平均年龄为 28 岁（范围在 16 至 44 岁之间），体重指数为 25.9（范围在 19.4 至 34.7 之间）。所有患者都接受了全身麻醉和多模式疼痛治疗。在门诊组中，46.8%的患者进行了辅助手术，而在住院组中，这一比例为34.0%。研究结果包括再次到急诊科（ED）就诊、再次入院和不良事件（采用修改后的辛克-丁多分类法）。有 6 名门诊患者（12.8%）住院时间超过 24 小时，其中 3 人计划当天出院，3 人未能当天出院，平均住院时间为 10.13 小时（5.65-23.8 小时）。住院患者的平均住院时间为 3.03 天（1.03 到 11.8 天不等）。无匹配患者当天出院。门诊患者的平均失血量为 523 毫升（范围在 200 到 900 之间），手术时间为 111.9 分钟（范围在 70.8 到 169.2 之间），而住院患者的平均失血量为 643 毫升（范围在 200 到 1,500 之间），手术时间为 121.2 分钟（范围在 75 到 259.8 之间）。有两名门诊患者和三名住院患者在七天内返回急诊室。90天后，两组患者均有一名患者再次入院：门诊组和住院组分别有一名患者伤口开裂需要冲洗和清创，一名患者下腹部出血需要栓塞治疗：结论：SDD PAO 的早期经验表明，其安全性与住院 PAO 相当。优化患者教育和围手术期管理将有助于促进其他中心的门诊 PAO 计划。Introduction: Timely access for young patients who have hip dysplasia can be challenging due to health system resource limitations such as operating room access and hospital beds. This study evaluated the safety and effectiveness of same-day discharge (SDD) peri-acetabular osteotomy (PAO).
Material and methods: There were 59 consecutive patients (mean age 30 years; range, 17 to 50; 60% women) scheduled for SDD. There were 47 outpatients matched with 47 inpatients based on age and a body mass index (BMI). Outpatients had a mean age of 28 years (range, 17 to 46) and BMI of 25.6 (range, 18.9 to 37.1), compared to inpatients between 2015 and 2020 (mean age 28 years, range, 16 to 44; BMI 25.9, range, 19.4 to 34.7). All patients received general anesthesia with multimodal pain management. In the outpatient group, 46.8% had adjunct procedures, compared to 34.0% in the inpatient group. Outcomes included revisits to the emergency department (ED), readmissions, and adverse events (using the modified Sink Dindo Classification). There were six outpatients (12.8%) who stayed in the hospital for more than 24 hours, with three planned and three having failed to be discharged the same day, averaging a length of stay of 10.13 hours (5.65 to 23.8). The mean length of stay for inpatients was 3.03 days (range, 1.03 to 11.8). None of the unmatched patients had a same-day discharge. Mean outpatient blood loss was 523 mL (range, 200 to 900), and surgery time was 111.9 minutes (range, 70.8 to 169.2), compared to 643 mL (range, 200 to 1,500) and 121.2 minutes (range, 75 to 259.8) for inpatients. There were two outpatients and three inpatients who returned to the ED within seven days. At 90 days, both groups had one readmission: a patient who had a wound dehiscence requiring irrigation and debridement and a patient who had an inferior epigastric bleed requiring embolization in outpatient and inpatient groups, respectively.
Conclusion: Early experience with SDD PAOs shows comparable safety to inpatient PAOs. Optimizing patient education and perioperative management will help facilitate outpatient PAO programs in other centers.
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