日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院課件

1、Same-Day Discharge in Total Joint ArthroplastyMay, 20182016級碩士(shush)研究生：羅澤宇研究生導(dǎo)師：周宗科教授第一頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院pThe demand for TJA is increasingpFast-track TJA: LOS 35kg/m22.39 1.06 - 5.400.035insulin-dependent diabetes4.021.06-15.300.041non-insulin-dependent diabetes3.271.29-8.340.013Age8

2、55.361.09-23.330.039第十一頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Conclusion pNo 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第十二頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Limita

3、tionspRetrospective studypThe function was not assessed pRisk Factors for Complications and readmission should be given more details第十三頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Article #22017 . JOALevel of Evidence Level III Retrospective study 第十四頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Article #2pAim: To compare the

4、 predictive ability of the risk assessment of “Outpatient Arthroplasty Risk Assessment Score (OARA)” ,“ASA”, “Charlson comorbidity index (CCI)”pDesign: retrospective studypOutcomes: sensitivity of the scalespGeneral character: 1120 consecutive THA and TKA patients Mean Age 62.3 yrs Mean BMI 32.4 521

5、 knees (53.2%) / 458 hips (46.8%)第十五頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院OARA score pIndiana university p9 comorbidity areas pLow risk: OARA 59pHigh risk: OARA 60第十六頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院OARA score J Arthroplasty. 2017 Aug;32(8):2325-2331第十七頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Three scales第十八頁，共三十二頁

6、。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Positive predictive value pOARA SCORE 59 discharge POD 0 or 1: 81.6%pASA 2 discharge POD 0 or 1: 56.4%pCCI=0 discharge POD 0 or 1: 70.3%第十九頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Conclusion pCurrent medical selection criteria for outpatientTJA, such as ASA, are crude pOARA Score rep

7、resents a more sensitive medical risk stratification for outpatient TJA第二十頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Article #32017 . CORRLevel of Evidence Level I Randomized study 第二十一頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Article #3pAim: To compare discharged on the same day as the surgery (outpatient, less than 12

8、-hour stay)with those who are discharged after an overnight hospital stay (inpatient) in THAspDesign: Multicenter, RCTspOutcomes: postoperative pain; perioperative complications; readmissionpGeneral character: 220 patients, M/F 117/103, age 60.0 8.7 y, BMI 27.9 4.4 kg/m2第二十二頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四

9、川大學(xué)華西醫(yī)院Inclusion and exclusion criteria 初次單側(cè)THA BMI40 Age10g/dL 無心肺疾病 術(shù)前不需輪椅 術(shù)前不長期鴉片(ypin)鎮(zhèn)痛 術(shù)后回家有良好照看第二十三頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Perioperative management pDirect anterior approach pSpinal anesthesiap24 hours of antibiotic 曲馬多酮咯酸普瑞巴林(b ln)塞來昔布?xì)浠傻乃苫前?hun n)過敏第二十四頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華

10、西醫(yī)院Discharge criteria p 走80英尺p上下樓p知曉家庭康復(fù)p上廁所p獨(dú)立起床p獨(dú)立日?；顒觩 術(shù)后小便p固體食物p疼痛控制良好p生命體征平穩(wěn)(pngwn)p無暈眩或嘔吐p良好的家庭照顧第二十五頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Demographics pGeneral character: 220 patients, M/F 117/103, age 60.0 8.7 y, BMI 27.9 4.4 kg/m2pNo difference noted between the groups第二十六頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-

11、四川大學(xué)華西醫(yī)院ResultsOutpatientInpatient P valueVAS PON12.8 2.53.3 2.30.12 VAS POD13.7 2.32.8 2.1 0.01VAS POW41.7 1.9 1.7 1.9 0.77HHS POW475 1875 140.77Reoperation 211Readmissions 140.21Contacts to staff2.4 1.9 2.4 2.2 0.94pOnly VAS POD1 noted a significant difference between the group第二十七頁，共三十二頁。日間手術(shù)在髖膝關(guān)

12、節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Conclusion pOutpatient THA can be comparable with inpatient with a strict inclusion and discharge criteria 第二十八頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院LimitationspOnly 220 THAs were evaluatedpThe applications of blood management, drainage and rehabilitation were not givenpThe cost of patient

13、s was not evaluated第二十九頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院Take home message pOutpatients TJA were comparable with inpatient in selected surgery in safety and complicationspOutpatients TJA can reduce the LOS and were cost savingpOutpatient Arthroplasty Risk Assessment (OARA) score was needed in risk str

14、atification p A strict discharge criteria should be meet before dischargep Rehabilitation and function should be assessed in future researchpPerioperative management, surgical and anesthesia technology should be optimal 第三十頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院第三十一頁，共三十二頁。日間手術(shù)在髖膝關(guān)節(jié)置換的應(yīng)用1-四川大學(xué)華西醫(yī)院內(nèi)容(nirng)總結(jié)Same-Day Dischar