日间手术在髋膝关节置换的应用1-四川大学华西医院.docx

Introduction Introduction 1X92 May, 2018 May, 2018 Same-Day Discharge in Total Joint Arthroplasty 2016级硕士研究生: 罗泽宇 研究生导师： ：TJ；周宗科教授 ：TJ； □The demand for TJA is increasing □Fast-track TJA: LOS 3 days □Outpatient: -discharged on same day postoperative ( less than 12-hour stay ) □Financial analysis -Outpatient TJA would save $300 million annually R7R在您學阻快 0 1KA LOS 2 奶年 年 年 2012 年 2013 年 NUM 年 2015| 2016 年 2017 年 □Safety is primary factor to be concerned Complication, mortality, readmission and reoperation □Risk factor and patient selection -General condition: age, gender, BMI Historical or current disease: diabetes, cardiac disease , pulmonary disease, renal disease □Surgical procedure -General or regional or spinal anesthesia -Standard or mini incision -Tourniquet, drainage □Perioperative management and discharge □Postoperative function and rehabilitation Article #1 1969 Copyright ? 2017 nv The Iournai. of Rone and Joint Surgery. Incorporate Same-Day Discharge Compared with InpatientHospitalization Following Hip and Knee Arthroplasty Bryce A. Basques, MD, Matthew W. Tetreault, MD? and Craig J. Della Valle, MD JBJSS—J ■ fw^n Mee far* ■inrtrshyntfOFi perfornieit nt the Depurtm顷可 Orth叩ue血 Surgery Kush Ummsi/y Meiitcal Center Chicugof Illinois JBJS S— J ■ fw^n Mee far* ■ 2017 ? JB JS Level of Evidence Level III Retrospective study Article #1 □Aim: to compare matched cohorts of patients who underwent same-day and inpatient hip or knee arthroplasty in terms of postoperative complications and 30-day readmission rates □Design: retrospective matched cohorts study □Data source: ACS-NSQIP registry from 517 US hospital from 2005-2014 □Outcomes: complications, readmission rates □ General character: -177,818 patients, 1,236 outpatients, 176,582 inpatients Demographics TABLE I Patient Characteritic by Same-Day Status Compared with Inpatient Status Characteristic inpatient* (N = 176.582) Same-Day* (N = 1.236) P Value Matched P Value Age (yr) 0.001 0-962 18 to 54 12.57% 18.61% 55 t