加速康复外科模式下全髋关节置换术后48h内出院危险因素分析

Analysis of risk factors of discharge within 48 hours after total hip arthroplasty under enhanced recovery mode

背景:加速康复外科(ERAS)理念应用于全髋/全膝关节置换术(THA/TKA)围手术期管理之后,患者的术后住院时间(LOS)已经明显缩短。术后LOS受到术前、术中及术后多种因素的影响。目的:探讨ERAS模式下THA术后48 h内出院的危险因素。方法:回顾性分析2018年1月1日至5月31日严格按照ERAS模式行初次THA的患者共101例。其中52例患者(51.5%)术后LOS≤48 h。记录患者的一般情况、诊断、术前髋关节畸形、并存疾病、血液学检查指标、手术相关指标、术后下地时间、疼痛视觉模拟评分(VAS)等指标。比较术后48 h内出院的患者与术后48 h后出院的患者以上指标的差异。采用多元Logistic回归分析法分析术后LOS的危险因素。结果:与术后48 h内出院的患者比较,术后48 h以内出院的患者男性比例较大(P=0.011)、ASA分级较低(P=0.032)、髋关节畸形比例较低(P=0.012)、麻醉时间较短(P=0.001)、术中输液量较少(P=0.002)、术后下地时间较早(P=0.013)、术后第1天ALB水平较高(P=0.021)、IL-6水平较低(P=0.018)、术后第1天疼痛VAS评分较低(P=0.014)。多元Logistic回归分析结果显示,患者年龄(OR 2.14,95%CI 1.16-3.31,P=0.012)、性别(男vs女,OR0.33,95%CI 0.17-0.61,P=0.007)、术前髋关节畸形(OR 2.81,95%CI 2.14-3.51,P=0.002)、ASA分级(OR1.57,95%CI 1.01-2.14,P=0.046)、手术时间(OR 1.71,95%CI 1.06-2.43,P=0.021)、术中输液量(OR 1.66,95%CI 1.23-2.24,P=0.031)、术后第1天ALB水平(OR 0.67,95%CI 0.43-0.91,P=0.028)等是术后LOS>48 h的危险因素。结论:患者的年龄大、女性、术前髋关节畸形、并存疾病、麻醉时间长、术中输液量大、术后第1天ALB水平低是ERAS模式下THA术后LOS>48 h的危险因素。

Background:After enhanced recovery after surgery(ERAS)was applied to perioperative management of total hip/knee arthroplasty(THA/TKA),the length of hospital stay(LOS)has been significantly shortened.Postoperative LOS is affected by various perioperative factors.Objective:To study the factors associated with discharge within 48 hours after THA under ERAS.Methods:A total of 101 patients who underwent primary THA in strict accordance with ERAS from January 1,2018 to May 31,2018 were enrolled in this retrospective analysis.Postoperative LOS was 48 h and less in 52(51.5%)patients.General conditions,diagnosis,preoperative hip deformity,comorbidities,hematological indicators,surgery-related indicators,postoperative off-bed time,VAS score were recorded.The above indicators were compared between patients discharged within48 hours and>48 hours after surgery.Multivariate logistic regression was used to analyze the influencing factors of postoperative LOS.Results:Postoperative discharge within 48 h was related to higher proportion of male patients(P=0.011),lower ASA grade(P=0.032),lower proportion of hip deformity(P=0.012),shorter anesthesia time(P=0.001),less intraoperative intravenous infusion(P=0.002),earlier off-bed(P=0.013),higher level of ALB on day 1 postoperatively(P=0.021),lower level of IL-6(P=0.018),lower VAS score(P=0.014).The results of multiple logistic regression analysis showed that patient’s age(OR=2.14,95%CI:1.16-3.31,P=0.012),gender(OR=0.33,95%CI:0.17-0.61,P=0.007),preoperative hip deformity(OR=2.81,95%CI:2.14-3.51,P=0.002),ASA grade(OR=1.57,95%CI:1.01-2.14,P=0.046),operative time(OR=1.71,95%CI:1.06-2.43,P=0.021),intraoperative infusion volume(OR=1.66,95%CI:1.23-2.24,P=0.031),and ALB level on the first day after surgery(OR=0.67,95%CI:0.43-0.91,P=0.028)were risk factors for postoperative LOS>48 h.Conclusions:Older age,females,postoperative hip deformity,comorbidities,long anesthesia time,large intraoperative infusion,low ALB on the first postoperative day are risk factors for LOS>48 h after THA under ERAS.