Feasibility analysis of day surgery for unicompartmental knee arthroplasty: a nested case-control study
LIU Lingjing1,2, LI Mengmeng1, LIU Yang1, SUN Yu1, XIE Qun1, FANG Xiaoyan1
1. Department of Anesthesiology,the Fourth Medical Center of PLA General Hospital,Beijing 100048, China; 2. College of Anesthesiology,Shanxi Medical University,Taiyuan 030000, China
Abstract：Objective To investigate the feasibility of the day surgery model of joint replacement by retrospectively analyzing the perioperative management and early regression of patients undergoing unicompartmental knee arthroplasty(UKA) in the day surgery model and the conventional inpatient model. Methods Patients receiving UKA day surgery under general anesthesia in the Fourth Medical Center of PLA General Hospital from May 2023 to September 2024 were selected as the day surgery group. Based on the patients' gender, age and other information, they were matched with concurrent hospitalized general anesthesia UKA patients according to 1:3 as the conventional surgery group. The basic condition of the patients, perioperative anesthesia management, length of stay, hospitalization cost, postoperative complications, and readmission rate were compared between the two groups. Results A total of 224 cases were included (56 cases in the day surgery group and 168 cases in the conventional surgery group). There were no statistically significant differences in the basic condition of the patients, ASA classification, or preoperative comorbidities between the groups (P>0.05); there were also no statistically significant differences in the intraoperative patients' mean arterial pressure, heart rate, anesthesia drug consumption, intraoperative fluid balance, or operative time between the groups (P>0.05); the patients in the day surgery group had significantly higher rates of preoperative retractile myotubular compared with the conventional surgery group, the preoperative retractor tube block rate was significantly higher in the day surgery group (71.4% vs. 36.9%, P＜0.05); there were no statistically significant differences in the postoperative patients' resting and exercise VAS scores, adverse reactions, or readmission rates (P>0.05); and the average hospital stay was (2.36±1.51)d in the day surgery group compared with (7.14±2.07)d in the conventional surgery group, with statistically significant difference (P＜0.05). There was statistically significant difference in the hospitalization cost [(30 100±7600)yuan vs.(38 500±12 100)yuan, P＜0.05)]. Conclusions The use of laryngeal mask general anesthesia combined with preoperative retractor tube block in patients undergoing unicompartmental arthroplasty is a safe and feasible mode of day surgery.
刘玲静, 李萌萌, 刘洋, 孙雨, 解群, 房晓燕. 单髁关节置换术日间手术可行性分析——一项巢式病例对照研究[J]. 武警医学, 2025, 36(2): 119-123.
LIU Lingjing, LI Mengmeng, LIU Yang, SUN Yu, XIE Qun, FANG Xiaoyan. Feasibility analysis of day surgery for unicompartmental knee arthroplasty: a nested case-control study. Med. J. Chin. Peop. Armed Poli. Forc., 2025, 36(2): 119-123.
Leung Y Y, Ma S, Noviani M, et al. Validation of screening questionnaires for evaluation of knee osteoarthritis prevalence in the general population of Singapore [J]. Int J Rheum Dis, 2018, 21(3): 629-638.
[2]
Cho H J, Morey V, Kang J Y, et al. Prevalence and risk factors of spine, shoulder, hand, hip, and knee osteoarthritis in community-dwelling Koreans older than age 65 years [J]. Clin Orthop Relat Res, 2015, 473(10): 3307-3314.
[3]
Murray D W, Parkinson R W. Usage of unicompartmental knee arthroplasty [J]. Bone Joint J, 2018, 100(4): 432-435.
Huang A, Ryu J J, Dervin G. Cost savings of outpatient versus standard inpatient total knee arthroplasty [J]. Can J Surg, 2017, 60(1): 57-62.
[6]
Richter D L, Diduch D R. Cost comparison of outpatient versus inpatient unicompartmental knee arthroplasty [J]. Orthop J Sports Med, 2017, 5(3): 2325967117694352.
[7]
Cadariu F, Enache A, Avram M, et al. Day surgery in Romania [J]. Ann Ital Chir, 2017, 88: 567-571.
Gondusky J S, Choi L, Khalaf N, et al. Day of surgery discharge after unicompartmental knee arthroplasty: an effective perioperative pathway [J]. J Arthroplasty, 2014, 29(3): 516-519.
Xu J, Cao J Y, Chaggar G S, et al. Comparison of outpatient versus inpatient total hip and knee arthroplasty: a systematic review and meta-analysis of complications [J]. J Orthop, 2020, 17: 38-43.
[12]
Pollock M, Somerville L, Firth A, et al. Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty: a systematic review of the literature [J]. JBJS Rev, 2016, 4(12): e4.
[13]
Vehmeijer S B W, Husted H, Kehlet H. Outpatient total hip and knee arthroplasty [J]. Acta Orthop, 2018, 89(2): 141-144.
[14]
Berger R A, Kusuma S K, Sanders S A, et al. The feasibility and perioperative complications of outpatient knee arthroplasty [J]. Clin Orthop Relat Res, 2009, 467(6): 1443-1449.
[15]
Bovonratwet P, Ondeck N T, Tyagi V, et al. Outpatient and inpatient unicompartmental knee arthroplasty procedures have similar short-term complication profiles [J]. J Arthroplasty, 2017, 32(10): 2935-2940.
[16]
Cross M B, Berger R. Feasibility and safety of performing outpatient unicompartmental knee arthroplasty [J]. Int Orthop, 2014, 38(2): 443-447.
[17]
Lovald S T, Ong K L, Malkani A L, et al. Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients [J]. J Arthroplasty, 2014, 29(3): 510-515.
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