Background

Perioperative advancements have made outpatient primary total hip arthroplasty (THA) a viable option for patients. This study evaluated the feasibility of expedited discharge after revision THA and compared 30-day outcomes to patients who had prolonged inpatient hospitalizations. The authors hypothesized that expedited discharge would not result in inferior 30-day outcomes.

Methods

Aseptic revision THAs in a national database were reviewed from 2013 to 2020. THAs were stratified by hospital length of stay (LOS) more or less than 24 hours. Demographics, comorbidities, preoperative laboratory values, American Society of Anesthesiology (ASA) scores, operative times, components revised, 30-day readmissions, and reoperations were compared. Multivariable analyses evaluated predictors of discharge prior to 24 hours, 30-day readmissions, and reoperations. Of 17,044 aseptic revision THAs, 211 were discharged within 24 hours.

Results

Accelerated discharge patients were younger, mean age 63 years (range, 20-92) versus 66 years (range, 18-94) (P < .01) had lower body mass index, mean 28.7 (range, 18.3-46.4) versus 29.9 (range, 17.3-52.5) (P = .01), and ASA scores (ASA, 1-2; 40.4-57.8%) (P < .01). Components revised had no association with LOS (P = .39); however, operative times were shorter and mean 100 minutes (range, 35-369) versus 139 minutes (range, 24-962) (P < .01) in accelerated discharge patients. Accelerated discharge patients had lower readmission rates (P < .01) but no difference in reoperation rates (P = .06).

Conclusion

Discharge less than 24 hours after revision THA is a feasible option for the correct patient and further efforts to decrease LOS should be evaluated.

中文翻译：

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无菌翻修后加速放电全髋关节置换术不能预测较差的 30 天结果

背景

围手术期的进步使门诊初次全髋关节置换术 (THA) 成为患者的可行选择。本研究评估了 THA 翻修后加快出院的可行性，并将 30 天的结果与住院时间延长的患者进行了比较。作者假设加速出院不会导致较差的 30 天结果。

方法

回顾了 2013 年至 2020 年国家数据库中的无菌翻修 THA。THA 按住院时间 (LOS) 多于或少于 24 小时进行分层。比较了人口统计学、合并症、术前实验室检查值、美国麻醉学会 (ASA) 评分、手术时间、修订的组件、30 天再入院和再次手术。多变量分析评估了出院前 24 小时、30 天再入院和再次手术的预测因素。在 17,044 例无菌翻修 THA 中，211 例在 24 小时内出院。

结果

加速出院患者更年轻，平均年龄 63 岁（范围 20-92）比 66 岁（范围 18-94）（P < .01）体重指数更低，平均 28.7（范围 18.3-46.4）比 29.9 （范围，17.3-52.5）（P  = .01）和 ASA 评分（ASA，1-2；40.4-57.8%）（P < .01）。修订的组件与 LOS 无关 ( P  = .39)；然而，加速出院患者的手术时间更短，平均 100 分钟（范围 35-369）与 139 分钟（范围 24-962）相比 ( P < .01)。加速出院患者的再入院率较低 ( P < .01)，但再手术率无差异 ( P  = .06)。

结论

翻修后 24 小时内出院对正确的患者来说是可行的选择，应评估进一步降低 LOS 的努力。