日间手术在髋膝关节置换的应用1-四川大学华西医院.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2018/5/24,#,Same-Day Discharge in Total,Joint Arthroplasty,May,2018,2016,级硕士研究生：,罗泽宇,研究生导师：,周宗科教授,The demand for TJA is increasing,Fast-track TJA:LOS 35kg/m,2,2.39,1.06-5.40,0.035,insulin-dependent diabetes,4.02,1.06-15.30,0.041,non-insulin-dependent diabetes,3.27,1.29-8.34,0.013,Age85,5.36,1.09-23.33,0.039,Conclusion,No significant differences in overall postoperative complications or readmission were found between matched cohorts of patients who underwent same-day and inpatient hip and knee arthroplasties,Limitations,Retrospective study,The function was not assessed,Risk Factors for Complications and readmission should be given more details,Article#2,2017.JOA,Level of Evidence Level III,Retrospective study,Article#2,Aim:To compare the predictive ability of the risk assessment of“Outpatient Arthroplasty Risk Assessment Score(OARA)”,“ASA”,“Charlson comorbidity index(CCI)”,Design,:retrospective study,Outcomes,:sensitivity of the scales,General character,:,1120 consecutive THA and TKA patients,Mean Age 62.3 yrs,Mean BMI 32.4,521 knees(53.2%)/458 hips(46.8%),OARA score,Indiana university,9 comorbidity areas,Low risk:OARA 59,High risk:OARA 60,OARA score,J Arthroplasty.2017 Aug;32(8):2325-2331,Three scales,Positive predictive value,OARA SCORE 59 discharge POD 0 or 1:,81.6%,ASA 2 discharge POD 0 or 1:,56.4%,CCI=0 discharge POD 0 or 1:,70.3%,Conclusion,Current medical selection criteria for outpatientTJA,such as ASA,are crude,OARA Score represents a more sensitive medical risk stratification for outpatient TJA,Article#3,2017.CORR,Level of Evidence Level I,Randomized study,Article#3,Aim:,To compare discharged on the same day as the surgery,(outpatient,less than 12-hour stay),with those who are discharged after an,overnight,hospital stay(inpatient)in THAs,Design,:Multicenter,RCTs,Outcomes,:postoperative pain;perioperative complications;readmission,General character,:220 patients,M/F 117/103,age 60.0 8.7 y,BMI 27.9 4.4 kg/m,2,Inclusion and exclusion criteria,初次单侧,THA,BMI40,Age10g/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,Perioperative management,Direct anterior approach,Spinal anesthesia,24 hours of antibiotic,曲马多,酮咯酸,普瑞巴林,塞来昔布,氢化可的松,磺胺过敏,Discharge criteria,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,General character,:,220 patients,M/F 117/103,age 60.0 8.7 y,BMI 27.9 4.4 kg/m,2,No difference noted between the groups,Results,Outpatient,Inpatient,P value,VAS PON1,2.8 2.5,3.3 2.3,0.12,VAS POD1,3.7 2.3,2.8 2.1,0.01,VAS POW4,1.7 1.9,1.7 1.9,0.77,HHS POW4,75 18,75 14,0.77,Reoperation,2,1,1,Readmissions,1,4,0.21,Contacts to staff,2.4 1.9,2.4 2.2,0.94,Only VAS POD1 noted a significant difference between the group,Conclusion,Outpatient THA can be comparable with inpatient with a strict inclusion and discharge criteria,Limitations,Only 220 THAs were evaluated,The applications of blood management,drainage and rehabilitation were not given,The cost of patients was not evaluated,Take home message,Outpatients TJA were comparable with inpatient in selected surgery in safety and complications,Outpatients,TJA can reduce the LOS and were cost saving,Outpatient Arthroplasty Risk Assessment(OARA)score was needed in risk stratification,A strict discharge criteria should be meet before discharge,Rehabilitation and function should be assessed in future research,Perioperative management,surgical and anesthesia technology should be optimal,Thanks for your attention,！,