Hip international : the journal of clinical and experimental research on hip pathology and therapy · 2019
The feasibility of outpatient conversion and revision hip arthroplasty in selected patients.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Crawford David A, Lombardi Adolph V, Berend Keith R, Morris Michael J, Adams Joanne B
Аннотация
BACKGROUND: Total hip arthroplasty (THA) continues moving to the outpatient arena, and may be feasible for some conversion and revision scenarios. Controversy surrounds appropriate patient selection. The purpose of this study is to report complications associated with outpatient revision and conversion THA, and to determine if comorbidities are associated with complications or overnight stay.
METHODS: From June 2013 through August 2018, 46 patients (47 hips) underwent conversion (n = 10) or revision (n = 37) THA at a free-standing ambulatory surgery centre. This represented only 6.3% of revision THA cases at our institution during the study period that were selected for outpatient surgery. Mean patient age was 58.0 years, and 52% of patients were males. 1 or more major comorbidities were present in 15 patients (32%) including 1 valvular disease, 7 arrhythmia, 2 thromboembolism history, 3 obstructive sleep apnoea, 3 chronic obstructive pulmonary disease, 2 asthma, 4 frequent urination, and 1 renal disease.
RESULTS: 44 (94%) patients were discharged same day without incident, none required transfer to acute facility, and 3 stayed overnight (2 convenience, 1 for medical reasons - urinary retention). The patient kept overnight for medical reasons had no major comorbidities. 3 patients were placed on an extended course of antibiotics, including 2 with positive intraoperative cultures and 1 for cellulitis. There were no major complications, readmissions, or subsequent surgeries within 90 days.
CONCLUSIONS: Outpatient revision hip arthroplasty is safe in selected patients undergoing minor or partial revisions. Presence of medical comorbidities was not associated with risk of complications. Medical optimisation and a multimodal programme to mitigate risk of blood loss and reduce narcotic need facilitate the safe performance of arthroplasty in an outpatient setting.
METHODS: From June 2013 through August 2018, 46 patients (47 hips) underwent conversion (n = 10) or revision (n = 37) THA at a free-standing ambulatory surgery centre. This represented only 6.3% of revision THA cases at our institution during the study period that were selected for outpatient surgery. Mean patient age was 58.0 years, and 52% of patients were males. 1 or more major comorbidities were present in 15 patients (32%) including 1 valvular disease, 7 arrhythmia, 2 thromboembolism history, 3 obstructive sleep apnoea, 3 chronic obstructive pulmonary disease, 2 asthma, 4 frequent urination, and 1 renal disease.
RESULTS: 44 (94%) patients were discharged same day without incident, none required transfer to acute facility, and 3 stayed overnight (2 convenience, 1 for medical reasons - urinary retention). The patient kept overnight for medical reasons had no major comorbidities. 3 patients were placed on an extended course of antibiotics, including 2 with positive intraoperative cultures and 1 for cellulitis. There were no major complications, readmissions, or subsequent surgeries within 90 days.
CONCLUSIONS: Outpatient revision hip arthroplasty is safe in selected patients undergoing minor or partial revisions. Presence of medical comorbidities was not associated with risk of complications. Medical optimisation and a multimodal programme to mitigate risk of blood loss and reduce narcotic need facilitate the safe performance of arthroplasty in an outpatient setting.