初次全膝关节置换术后加速康复及术后48 h出院危险因素分析

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Abstract Objective To investigate effectiveness and safety of enhanced recovery after surgery (ERAS) in primary total knee arthroplasty (TKA) and to analyze risk factors of prolongation of length of stay (LOS) after TKA.Methods A total of 182 primary TKA cases receiving ERAS from July to October in 2018 in Department of Orthopaedics in Beijing Jishuitan Hospital Huilongguan Branch were retrospectively selected.The mean age of them was (65.2±7.7) years (Range，22 to 86 years) which included 37 male and 145 female patients.LOS after TKA，complications within 1 month and 1month readmission rate of this case series were evaluated.Risk factors including age，gender，body mass index (BMI)，etiology，American society of anesthesiologists (ASA) grade，pre operative albumin level，pre and post operative hemoglobin level and surgeon were analyzed for prolongation of LOS after TKA.Results The mean LOS after TKA under ERAS mode was (2.8±0.9) days，and the LOS after TKA in 82 cases (45.1%) was no more than 48 hours.Seven cases (3.8%) suffered complications within 1 month after TKA，including 2 cases of symptomatic deep venous thrombosis of lower limb (1.1%)，2 cases of severe medical complications (1.1%，1 case of gastrointestinal bleeding and 1 case of pneumonia)，and 3 cases of superficial wound infection (1.6%).Three cases were readmitted within 1 month (1.6%，2 cases for severe medical complications and 1 case for superficial wound infection).The mean ASA grade of LOS＞48 h group was higher than LOS≤48 h group (P＝0.030)，while the ratio of rheumatoid arthritis to osteoarthritis was less (P＝0.030).The surgeon is another influencing factor for LOS after TKA (P＝0.040).Conclusion The application of ERAS on primary TKA is safe and helpful.Preoperative optimization of medical condition is important for achieving reduced LOS，improved outcome，and early recovery.

Key words： total knee arthroplasty enhanced recovery after surgery length of stay complication readmission

Corresponding Authors: Zhou Yixin

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	Yin Xinghua
	Ma Zhuyi
	Gu Jianming
	Feng Gang
	Bao Qianjun
	Gao Zhenbin
	Zhou Yixin

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Yin Xinghua,Ma Zhuyi,Gu Jianming, et al. Enhanced Recovery after Primary Total Knee Arthroplasty and Analysis of Risk Factors for Discharge after 48 Hours of Postoperative Period[J]. sygkzz, 2023, 29(5): 400-.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2023/V29/I5/400

［1］王星，许宏，谢锦伟，等.加速康复外科模式下全髋关节置换术后48 h内出院危险因素分析［J］.中华骨与关节外科杂志，2021，14(3)：168-174.
［2］童培建.髋膝关节置换围手术期加速康复专家共识［J］.实用骨科杂志，2021，27(11)：961-965.
［3］Sloan M，Premkumar A，Sheth NP.Projected volume of primary total joint arthroplasty in the U.S. 2014 to 2030［J］.J Bone Joint Surg (Am)，2018，100(17)：1455-1460.
［4］Darrith B，Frisch NB，Tetreault MW，et al.Inpatient versus outpatient arthroplasty：A single-surgeon，matched cohort analysis of 90-day complications［J］.J Arthroplasty，2019，34(2)：221-227.
［5］Novack TA，Kurowicki J，Issa K，et al.Accelerated discharge following total knee arthroplasty may be safe in a teaching institution［J］.J Knee Surg，2020，33(1)：8-11.
［6］Sloan M，Sheth NP.Length of stay and inpatient mortality trends in primary and revision total joint arthroplasty in the United States，20002014［J］.J Orthop，2018，15(2)：645-649.
［7］Stone AH，Dunn L，MacDonald JH，et al.Reducing length of stay does not increase emergency room visits or readmissions in patients undergoing primary hip and knee arthroplasties［J］.J Arthroplasty，2018.33(8)：2381-2386.
［8］贾俊秀，唐冲，张清华，等.加速康复外科在全膝关节置换术中安全性及有效性的Meta分析［J］.实用骨科杂志，2020，26(6)：499-503.
［9］Lovald S，Ong K，Lau E，et al.Patient selection in outpatient and shortstay total knee arthroplasty［J］.J Surg Orthop Adv，2014，23(1)：2-8.
［10］Kay AB，Ponzio DY，Bell CD，et al.Predictors of successful early discharge for total hip and knee arthroplasty in octogenarians［J］.HSS J，2022，18(3)：393-398.
［11］Khanna V，Gurava Reddy AV，Daultani D，et al.When can I go home after my knee replacement? factors affecting the duration of inhospital stay after knee replacement［J］.Eur J Orthop Surg Traumatol，2019，29(8)：1719-1728.
［12］Jauregui JJ，Kapadia BH，Dixit A，et al.Thirty-day complications in rheumatoid patients following total knee arthroplasty［J］.Clin Rheumatol，2016，35(3)：595-600.
［13］Edwards PK，Kee JR，Mears SC，et al.Is rapid recovery hip and knee replacement possible and safe in the octogenarian patient?［J］ J Arthroplasty，2018，33(2)：316-319.
［14］Otero JE，Gholson JJ，Pugely AJ，et al.Length of hospitalization after joint arthroplasty：does early discharge affect complications and readmission rates?［J］ J Arthroplasty，2016，31(12)：2714-2725.
［15］Ross TD，Dvorani E，Saskin R，et al.Temporal trends and predictors of thirty-day readmissions and emergency department visits following total knee arthroplasty in Ontario between 2003 and 2016［J］.J Arthroplasty，2020，35(2)：364-370.
［16］Roger C，Debuyzer E，Dehl M，et al.Factors associated with hospital stay length，discharge destination，and 30-days readmission rate after primary hip or knee arthroplasty：retrospective cohort study［J］ Orthop Traumatol Surg Res，2019，105(5)：949-955.

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