METHODS: Prospectively collected data were reviewed for all SDD primary joint arthroplasties between January 2013 and August 2023. There were 8 surgeons who performed 7,258 cases at hospital outpatient (n = 4,288) or ambulatory surgery centers (n = 2,970). This included 3,239 total hip arthroplasties, 1,503 total knee arthroplasties, and 2,516 unicompartmental knee arthroplasties. The ASA 1 group comprised 506 subjects, compared to 5,005 for ASA 2 and 1,736 for ASA 3. The primary outcomes included emergency department (ED) visits, readmissions, complications, and revisions within 24 hours and 90 days of surgery. The ASA 3 group was older (ASA 1 = 55 versus ASA 2 = 63 versus ASA 3 = 66 years; P < .01) and had a higher body mass index (ASA 1 = 25.4 versus ASA 2 = 28.5 versus ASA 3 = 32.7; P < .01).
RESULTS: There were no differences between ASA groups in joint-related ED visits, readmissions, and complications within 24 h and 90 days of surgery (P > .05). Subjects in the ASA 3 group experienced greater 90-day revisions compared to the other groups (ASA 1 = 1 of 506, 0.2% versus ASA 2 = 15 of 5,005, 0.3% versus ASA 3 = 15 of 1,736, 0.9%; P = .01). Regarding systemic events, ASA 1 subjects experienced significantly greater 24-hour complications (8 of 506, 1.6%) and ED visits (5 of 506, 1.0%), and the ASA 3 subjects had a higher incidence of 90-day readmissions (19 of 1,736, 1.1%) compared to the other groups (P < .05). Within 24 hours of discharge, urinary retention and syncope were the most frequent complications that required additional health care utilization.
CONCLUSIONS: Medically optimized patients categorized as ASA 3 can safely undergo SDD hip and knee arthroplasty without increased risk of 24-hour or 90-day complications. Patient preference for outpatient care, reliable social support, and independent functional status are imperative for a successful outpatient program.
方法:回顾了2013年1月至2023年8月期间所有SDD初次关节置换术的前瞻性收集数据。有8名外科医生在医院门诊(n=4,288)或门诊手术中心(n=2,970)进行了7,258例手术。这包括3,239个全髋关节置换术(THA),1,503例膝关节置换术(TKAs),和2,516个单室膝关节置换术(UKAs)。ASA1组包括506名受试者,相比之下,ASA2为5,005,ASA3为1,736。主要结果包括急诊科(ED)就诊,再入院,并发症,并在手术后24小时和90天内进行修订。ASA3组年龄较大(ASA1=55,ASA2=63,ASA3=66岁;P<0.01),体重指数(BMI)较高(ASA1=25.4,ASA2=28.5,ASA3=32.7;P<0.01)。
结果:ASA组之间的联合相关ED访视没有差异,再入院,术后24小时和90天内的并发症(P>0.05)。与其他组相比,ASA3组的受试者经历了更大的90天修订(ASA1=1/506,0.2%对ASA2=15/5,005,0.3%对ASA3=15/1,736,0.9%;P=0.01)。关于系统性事件,ASA1受试者的24小时并发症(506中的8例,1.6%)和ED访视(506中的5例,1.0%)明显增多,与其他组相比,ASA3组受试者的90天再入院发生率较高(1,736例中的19例,为1.1%)(P<0.05)。出院后24小时内,尿潴留和晕厥是最常见的并发症,需要额外的医疗服务.
结论:被归类为ASA3的医学优化患者可以安全地进行SDD髋和膝关节置换术,而不会增加24小时或90天并发症的风险。患者对门诊护理的偏好,可靠的社会支持,独立的功能状态对于成功的门诊计划至关重要。