Joint arthroplasty Perioperative Surgical Home:Impact of patient characteristics on postoperative outcomes  

作　　者：Duy L Phan Kyle Ahn Joseph B Rinehart Michael-David Calderon Wei-Der Wu Ran Schwarzkopf 

机构地区：[1]Department of Orthopaedic Surgery, Universityof California, Irvine Medical Center [2]Department of Anesthesiology, University of California,Irvine Medical Center [3]Division of Adult Reconstruction, Departmentof Orthopaedic Surgery, New York University Langone Medical Center

出　　处：《World Journal of Orthopedics》2016年第6期376-382,共7页世界骨科杂志（英文版）

摘　　要：AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home(PSH) program.METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty(THA) and total knee arthroplasty(TKA).Patients were preoperatively stratified based on specific procedure performed,age,gender,body mass index(BMI),American Society of Anesthesiologists Physical Classification System(ASA) score,and Charleston Comorbidity Index(CCI) score.The primary outcome criterion was hospital length of stay(LOS).Secondary criteria including operative room(OR) duration,trans-fusion rate,Post-Anesthesia Care Unit(PACU) stay,readmission rate,post-operative complications,and discharge disposition.For each outcome,the predictor variables were entered into a generalized linear model with appropriate response and assessed for predictive relationship to the dependent variable.Significance level was set to 0.05.RESULTS:A total of 337 patients,200 in the TKA cohort and 137 in the THA cohort,were eligible for the study.Nearly two-third of patients were female.Patient age averaged 64 years and preoperative BMI averaged 29 kg/m2.The majority of patients were ASA score Ⅲ and CCI score 0.After analysis,ASA score was the only variable predictive for LOS(P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d.ASA score was also the only variable predictive for readmission rate(P = 0.0332).BMI was the only variable predictive for PACU duration(P = 0.0136).Specific procedure performed,age,gender,and CCI score were not predictive for any of the outcome criteria.OR duration,transfusion rate,postoperative complications or discharge disposition were not significantly associated with any of the predictor variables.CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidiAIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home(PSH) program.METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty(THA) and total knee arthroplasty(TKA).Patients were preoperatively stratified based on specific procedure performed,age,gender,body mass index(BMI),American Society of Anesthesiologists Physical Classification System(ASA) score,and Charleston Comorbidity Index(CCI) score.The primary outcome criterion was hospital length of stay(LOS).Secondary criteria including operative room(OR) duration,trans-fusion rate,Post-Anesthesia Care Unit(PACU) stay,readmission rate,post-operative complications,and discharge disposition.For each outcome,the predictor variables were entered into a generalized linear model with appropriate response and assessed for predictive relationship to the dependent variable.Significance level was set to 0.05.RESULTS:A total of 337 patients,200 in the TKA cohort and 137 in the THA cohort,were eligible for the study.Nearly two-third of patients were female.Patient age averaged 64 years and preoperative BMI averaged 29 kg/m2.The majority of patients were ASA score Ⅲ and CCI score 0.After analysis,ASA score was the only variable predictive for LOS(P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d.ASA score was also the only variable predictive for readmission rate(P = 0.0332).BMI was the only variable predictive for PACU duration(P = 0.0136).Specific procedure performed,age,gender,and CCI score were not predictive for any of the outcome criteria.OR duration,transfusion rate,postoperative complications or discharge disposition were not significantly associated with any of the predictor variables.CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidi

关 键 词：PERIOPERATIVE SURGICAL HOME ARTHROPLASTY Length of stay American SOCIETY of ANESTHESIOLOGISTS Physical Classification System Body mass index 

分 类 号：R687.4[医药卫生—骨科学]