Abstract：
BACKGROUND: Recent expansion in the indications for outpatient total joint arthroplasty has led to debates over patient selection. The purpose of this study was to compare early clinical outcomes and complications of same-day discharge (SDD) hip and knee arthroplasties from a high-volume institution based on the American Society of Anesthesiologists (ASA) physical status classification.
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.
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.
摘要：
背景：最近门诊全关节置换术适应症的扩大引起了对患者选择的争论。这项研究的目的是比较基于美国麻醉师协会（ASA）身体状态分类的高容量机构的当日出院（SDD）髋关节和膝关节置换术的早期临床结果和并发症。
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。
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。
