Background

Total joint arthroplasty is rapidly shifting to the outpatient space. One of the challenges of same-day discharge adoption has been determining which patients are suitable candidates. Risk assessment tools have been developed, including the Outpatient Arthroplasty Risk Assessment (OARA) score. The purpose of this study was to assess its predictive utility.

Methods

A retrospective review was performed on all total joint arthroplasties performed at a single ambulatory surgery center in 2018, yielding a cohort of 1,105 patients (1,332 arthroplasties). The institution’s outpatient criteria required optimization of all medical conditions; if the patient had no failing organ, they were candidates for same-day discharge. OARA scores were calculated based on preoperative histories and physical examinations. Analyses were performed on the statistical utility of the OARA score in predicting successful same-day discharge. The mean age was 59 years (range, 27-82), the mean body mass index was 33.3 kg/m² (range, 16-66), and 51.5% were women. A total of 45% of patients had one or more major comorbidity.

Results

There were 81.6% of patients who had an acceptable OARA score (<60). In addition, 97% of patients who had an “unacceptable” OARA score were successfully discharged the same day. There were 23 patients who required inpatient observation; of these, 7 (30.4%) had an OARA score ≥60.

Conclusion

The OARA score was accurate in predicting patients who successfully had same-day discharge but poor at predicting who would not. This system is time consuming and may be too restrictive on which patients are candidates for outpatient arthroplasty. Surgeons may consider a more simplified criteria for outpatient arthroplasty.

中文翻译：

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是否需要“门诊关节置换术风险评估评分”来预测门诊关节置换术候选人的安全选择？

背景

全关节置换术正在迅速转移到门诊空间。采用当天出院的挑战之一是确定哪些患者是合适的候选人。已经开发出风险评估工具，包括门诊关节置换术风险评估 (OARA) 评分。本研究的目的是评估其预测效用。

方法

对 2018 年在单一门诊手术中心进行的所有全关节置换术进行了回顾性审查，得出了 1,105 名患者（1,332 例关节置换术）的队列。该机构的门诊标准要求优化所有医疗条件；如果患者没有器官衰竭，则他们是当天出院的候选人。OARA 评分是根据术前病史和体格检查计算得出的。对 OARA 评分在预测当天成功出院方面的统计效用进行了分析。平均年龄为 59 岁（范围 27-82），平均体重指数为 33.3 kg/m ²（范围 16-66），女性占 51.5%。共有 45% 的患者有一种或多种主要合并症。

结果

有 81.6% 的患者具有可接受的 OARA 评分（<60）。此外，97% 的 OARA 评分为“不可接受”的患者当天成功出院。需要住院观察23例；其中，7 人 (30.4%) 的 OARA 评分≥60。

结论

OARA 评分可以准确预测当天成功出院的患者，但不能准确预测出院患者。该系统非常耗时，并且对于门诊关节置换术的候选患者可能过于严格。外科医生可能会考虑更简化的门诊关节置换术标准。