背景:许多国家都使用短期关节置换方案,但文献中对安全性结果的研究很少。我们旨在系统地回顾短期治疗方案与常规治疗全髋关节(THR)和膝关节置换(KR)安全性的证据。和最佳的患者选择。
方法:系统综述和荟萃分析。随机对照试验(RCT)和准实验研究,包括比较组报告14项安全性结果(住院再入院,重新操作,失血,急诊部门的访问,感染,死亡率,神经血管损伤,其他并发症,假体周围骨折,术后跌倒,静脉血栓栓塞,伤口并发症,位错,包括术后90天内≥18岁接受原发性THR或KR的成年人。次要结果是患者人口统计学或临床特征与患者结果之间的关联。在2000年1月至2023年5月之间搜索了四个数据库。评估证据的偏倚风险和确定性。
结果:纳入了49项研究。基于低确定性RCT证据,短期住院计划可能不会降低再入院率(OR0.95,95%CI0.12-7.43);输血需求(OR1.75,95%CI0.27-11.36);神经血管损伤(OR0.31,95%CI0.01-7.92);其他并发症(OR0.63,95%CI0.26-1.53);或僵硬度(OR1.04,95%CI0.53-2.05).对于注册研究,重新接纳没有区别,感染,神经血管损伤,其他并发症,静脉血栓栓塞,或伤口并发症,但死亡率和脱位降低。对于中断的时间序列研究,再入院没有区别,重新操作,失血量,急诊部门的访问,感染,死亡率,或神经血管损伤;减少输血和其他并发症的几率,但假体周围骨折的几率增加了.对于其他观察性研究,再入院的风险增加,失血量无差异,感染,其他并发症,或伤口并发症,降低了需要输血的几率,降低死亡率,减少静脉血栓栓塞症.一项研究检查了与最佳患者选择相关的结果;它报告了短期男性和女性参与者的失血量相当(p=0.814)。
结论:有低确定性证据表明,THR和KR的短期住院计划可能具有非较差的90天安全性结果。关于影响最佳患者选择的因素的证据很少;这仍然是一个重要的知识鸿沟。
Short-stay joint replacement programmes are used in many countries but there has been little scrutiny of safety outcomes in the literature. We aimed to systematically
review evidence on the safety of short-stay programmes versus usual care for total hip (THR) and knee replacement (KR), and optimal patient selection.
A systematic
review and meta-analysis. Randomised controlled trials (RCTs) and quasi-experimental studies including a comparator group reporting on 14 safety outcomes (hospital readmissions, reoperations, blood loss, emergency department visits, infection, mortality, neurovascular injury, other complications, periprosthetic fractures, postoperative falls, venous thromboembolism, wound complications, dislocation, stiffness) within 90 days postoperatively in adults ≥ 18 years undergoing primary THR or KR were included. Secondary outcomes were associations between patient demographics or clinical characteristics and patient outcomes. Four databases were searched between January 2000 and May 2023. Risk of bias and certainty of the evidence were assessed.
Forty-nine studies were included. Based upon low certainty RCT evidence, short-stay programmes may not reduce readmission (OR 0.95, 95% CI 0.12-7.43); blood transfusion requirements (OR 1.75, 95% CI 0.27-11.36); neurovascular injury (OR 0.31, 95% CI 0.01-7.92); other complications (OR 0.63, 95% CI 0.26-1.53); or stiffness (OR 1.04, 95% CI 0.53-2.05). For registry studies, there was no difference in readmission, infection, neurovascular injury, other complications, venous thromboembolism, or wound complications but there were reductions in mortality and dislocations. For interrupted time series studies, there was no difference in readmissions, reoperations, blood loss volume, emergency department visits, infection, mortality, or neurovascular injury; reduced odds of blood transfusion and other complications, but increased odds of periprosthetic fracture. For other observational studies, there was an increased risk of readmission, no difference in blood loss volume, infection, other complications, or wound complications, reduced odds of requiring blood transfusion, reduced mortality, and reduced venous thromboembolism. One study examined an outcome relevant to optimal patient selection; it reported comparable blood loss for short-stay male and female participants (p = 0.814).
There is low certainty evidence that short-stay programmes for THR and KR may have non-inferior 90-day safety outcomes. There is little evidence on factors informing optimal patient selection; this remains an important knowledge gap.