背景:在提高手术后恢复的计划中,在常规的初次全关节置换术(TJA)后不放置封闭的引流管变得越来越可接受。然而,引流管使用对TJA输血率和术后住院时间(PLOS)的影响仍存在争议.因此,我们旨在比较常规原发性TJA中使用引流管和不使用引流管的情况,以确定输血率和PLOS的差异.
方法:我们分析了12,992例接受原发性单侧TJA的患者的数据:6325例全膝关节置换术(TKA)和6667例全髋关节置换术(THA)。根据TKA和THA术后是否接受引流,将患者分为两组。我们从患者的电子健康记录中提取输血和PLOS信息,并通过逻辑和线性回归分析对数据进行分析。
结果:输血率和PLOS分别为15.07%和7.75±3.61天,分别,引流组为6.72%和6.54±3.32天,分别,在TKA后的无排水组中。输血率和PLOS分别为20.53%和7.00±3.35天,分别,引流组为13.57%和6.07±3.06天,分别,在THA之后的无排水组中。调整以下变量后:年龄,性别,身体质量指数,骨科诊断,高血压,2型糖尿病,冠心病,慢性阻塞性肺疾病,术前血红蛋白,白蛋白,镇痛药的使用,麻醉,美国麻醉医师学会班,氨甲环酸的使用,术中出血,手术时间,和止血带使用(TKA),引流使用与更高的输血率显着相关(TKA的风险比=2.812,95%置信区间(CI)2.224-3.554,P<0.001,TKA的风险比=1.872,95%CI1.588-2.207,P<0.001)和更长的PLOS(部分回归系数(B)=1.099,95%CI0.879-1.318,P<0.001,标准回归系数(B=0.6两组创面并发症无明显差异。
结论:我们的研究结果表明,在接受常规原发性TJA的患者中,使用引流管与更高的输血率和更长的PLOS相关。不建议在原发性单侧TJA中常规使用术后引流。
BACKGROUND: In an enhanced recovery after surgery program, not placing a closed suction
drain following routine primary total joint arthroplasty (TJA) is becoming more acceptable. However, the influence of
drain use on transfusion rate and postoperative length of stay (PLOS) in TJA remains controversial. Therefore, we aimed to compare
drain use with no
drain in routine primary TJA to determine the differences in transfusion rate and PLOS.
METHODS: We analyzed the data from 12,992 patients undergoing primary unilateral TJA: 6325 total knee arthroplasties (TKA) and 6667 total hip arthroplasties (THA). Patients were divided into two groups according to whether they received a drain postoperatively following TKA and THA. We extracted information for transfusion and PLOS from patients\' electronic health records and analyzed the data by logistic and linear regression analyses.
RESULTS: The transfusion rate and PLOS were 15.07% and 7.75 ± 3.61 days, respectively, in the drain group and 6.72% and 6.54 ± 3.32 days, respectively, in the no-
drain group following TKA. The transfusion rate and PLOS were 20.53% and 7.00 ± 3.35 days, respectively, in the drain group and 13.57% and 6.07 ± 3.06 days, respectively, in the no-
drain group following THA. After adjusting for the following variables: age, gender, body mass index, orthopedic diagnoses, hypertension, type 2 diabetes, coronary heart disease, chronic obstructive pulmonary disease, preoperative hemoglobin, albumin, analgesic use, anesthesia, American Society of Anesthesiologists class, tranexamic acid use, intraoperative bleeding, operative time, and tourniquet use (for TKA), drain use correlated significantly with a higher transfusion rate (risk ratio = 2.812, 95% confidence interval (CI) 2.224-3.554, P < 0.001 for TKA and risk ratio = 1.872, 95% CI 1.588-2.207, P < 0.001 for THA) and a longer PLOS (partial regression coefficient (B) = 1.099, 95% CI 0.879-1.318, P < 0.001, standard regression coefficient (B\') = 0.139 for TKA; B = 0.973, 95% CI 0.695-1.051, P < 0.001, and B\' = 0.115 for THA). Two groups showed no significant difference in wound complications.
CONCLUSIONS: Our findings indicated that drain use was associated with a higher transfusion rate and a longer PLOS in patients undergoing routine primary TJA. The routine use of postoperative drainage is not recommended in primary unilateral TJA.