Are Patients Being Appropriately Selected for Same-Day Discharge Total Knee Arthroplasty?,The Journal of Arthroplasty

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Are Patients Being Appropriately Selected for Same-Day Discharge Total Knee Arthroplasty?
The Journal of Arthroplasty ( IF 3.5 ) Pub Date : 2022-09-24 , DOI: 10.1016/j.arth.2022.09.024
William G Cumbie ₁ , Jared A Warren ₁ , Bryan L Demyan ₁ , Robert M Molloy ₁ , Michael R Bloomfield ₁ , Carlos A Higuera ₂ , John P McLaughlin ₁

Affiliation

Background

Decreased cost associated with same-day discharge (SDD) total knee arthroplasty (TKA) has led to an increased interest in this topic. The purpose of this study is to investigate whether there is a population of TKA patients in which SDD has similar rates of 30-day complications compared to patients discharged on postoperative day 1 or 2.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2018, 6,327 TKA patients who had a SDD (length of stay [LOS] = 0) were matched to TKA patients who had an LOS of 1 or 2 days. All SDD patients were successfully matched 1:1 using the morbidity probability variable (a composite variable of demographics, comorbidities, and laboratory values). Patients were divided into quartiles based on their morbidity probability. Bivariate logistic regressions were then used to compare any complication and major complication rates in the SDD quartiles to the corresponding quartiles with an LOS of 1 or 2 days.

Results

When comparing the 1st quartiles (healthiest), there was no difference between the cohorts in any complication (odds ratio [OR] = 0.960, 95% CI 0.552-1.670, P = .866) and major complications (OR = 0.999, 95% CI = 0.448-2.231, P = .999). The same was observed in quartile 2 (any complications: OR = 1.161, 95% CI = 0.720-1.874, P = .540). Comparing the third quartiles, there was an increase in all complications with SDD (OR = 1.784, 95% CI = 1.125-2.829, P = .014), but no difference in major complications (OR = 1.635, 95% CI = 0.874-3.061, P = .124). Comparing the fourth quartiles (least healthy), there was an increase in all complications (OR = 1.384, 95% CI = 1.013-1.892, P = .042) and major complications (OR = 1.711, 95% CI = 1.048-2.793, P = .032) with SDD.

Conclusion

The unhealthiest 50% of patients in this study who underwent SDD TKA were at an increased risk of having any complication, calling into question the current state of patient selection for SDD TKA.

Level of Evidence

III.

中文翻译：

患者是否适当地为同一天出院的总膝关节置换术选择？

背景

与当天出院 (SDD) 全膝关节置换术 (TKA) 相关的成本降低导致人们对该主题的兴趣增加。本研究的目的是调查是否存在 TKA 患者群体，其中 SDD 的 30 天并发症发生率与术后第 1 天或第 2 天出院的患者相似。

方法

使用 2012 年至 2018 年美国外科医师学会国家外科质量改进计划数据库，将 6,327 名 SDD（住院时间 [LOS] = 0）的 TKA 患者与 LOS 为 1 或 2 天的 TKA 患者相匹配。所有 SDD 患者均使用发病概率变量（人口统计学、合并症和实验室值的复合变量）以 1:1 的比例成功匹配。根据发病概率将患者分为四分位数。然后使用双变量逻辑回归将 SDD 四分位数中的任何并发症和主要并发症发生率与 LOS 为 1 或 2 天的相应四分位数进行比较。

结果

比较第一个四分位数（最健康）时，队列之间在任何并发症（比值比 [OR] = 0.960，95% CI 0.552-1.670， P = .866）和主要并发症（OR = 0.999，95%）方面没有差异CI = 0.448-2.231，P = .999）。在四分位数 2 中观察到相同情况（任何并发症：OR = 1.161，95% CI = 0.720-1.874，P = .540）。比较第三个四分位数，SDD 的所有并发症均有所增加（OR = 1.784，95% CI = 1.125-2.829，P = .014），但主要并发症没有差异（OR = 1.635，95% CI = 0.874- 3.061，P = .124）。比较第四个四分位数（最不健康），所有并发症均有所增加（OR = 1.384，95% CI = 1.013-1.892，P = .042）和 SDD 的主要并发症（OR = 1.711，95% CI = 1.048-2.793，P = .032）。