全膝关节置换术后早期过夜休假：优化住院时间和资源利用的新策略

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-08-19 DOI:10.1016/j.jor.2025.08.028

Yoshinori Ishii , Hideo Noguchi , Junko Sato , Ikuko Takahashi , Hana Ishii , Ryo Ishii , Kai Ishii , Shin-ichi Toyabe

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引用次数: 0

摘要

与西方捆绑支付模式相比，日本按服务收费的医疗保健系统导致全膝关节置换术（TKA）后住院时间（LOS）更长，从而推高了成本。我们的机构实行提前临时“初始过夜假”（IOL），以方便提早出院和优化资源利用。本研究探讨原发性TKA术后人工晶状体的特点及影响因素。方法对2002年至2024年间408例（505膝）行原发性全膝关节置换术的骨关节炎患者进行回顾性队列研究。所有患者均接受标准化手术和早期完全负重康复。我们分析了人工晶状体及其与患者人口统计学、手术参数和术前健康指标的相关性。采用单因素和多因素分析探讨影响人工晶状体的因素。结果中位人工晶状体植入术15天（IQR: 10 - 18），术后第10天和第20天分别有42%和79%的患者成功植入术。单因素分析显示，只有年龄与IOL显著相关（p < 0.001, r = 0.216）。性别和美国麻醉医师协会的身体状况对人工晶状体没有影响。IOL与总LOS之间存在微弱但显著的相关性（p < 0.001, r = 0.300）。多因素分析证实年龄是延长人工晶状体的重要预测因素（p = 0.002）。结论TKA术后早期过夜休假与较短的LOS和改善的ADL独立性相关，特别是在年轻患者中。这种以患者为导向的做法提供了一种实用的解决方案，以优化医院资源利用，解决日本医疗保健系统中长期住院的挑战，促进高效和以患者为中心的TKA康复。

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Early initial overnight leave after total knee arthroplasty: A novel strategy for optimizing length of stay and resource utilization

Background

Japan's fee-for-service healthcare system leads to longer hospital stays (LOS) after total knee arthroplasty (TKA) compared to Western bundled payment models, driving up costs. Our institution implements early temporary “initial overnight leave” (IOL) to facilitate earlier home discharge and optimize resource use. This study investigates IOL's characteristics and influencing factors after primary TKA.

Methods

We conducted a retrospective cohort study of 408 osteoarthritis patients (505 knees) undergoing primary TKA between 2002 and 2024. All received standardized surgery and early full weight-bearing rehabilitation. We analyzed IOL and its correlation with patient demographics, surgical parameters, and preoperative health markers. Factors influencing IOL were examined using univariate and multivariate analyses.

Results

The median IOL was 15 days (IQR: 10–18), with 42 % of patients achieving leave by day 10 and 79 % by day 20. Univariate analysis showed only age significantly correlated with IOL (p < 0.001, r = 0.216). Neither sex nor American Society of Anesthesiologists Physical Status influenced IOL. A weak but significant correlation existed between IOL and total LOS (p < 0.001, r = 0.300). Multivariate analysis confirmed age as a significant predictor of longer IOL (p = 0.002).

Conclusions

Early initial overnight leave after TKA is associated with shorter LOS and improved ADL independence, particularly in younger patients. This patient-driven practice offers a practical solution to optimize hospital resource utilization and address prolonged hospitalization challenges within Japan's healthcare system, promoting efficient and patient-centered TKA rehabilitation.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.