Application Of Enhanced Recovery After Surgery In Total Hip Arthroplasty And Influencing Factors Of Unplanned Readmission

Objective:I.To explore the safety and effectiveness of enhanced recovery after surgery strategy in total hip arthroplasty and its influence on patient satisfaction and postoperative readmission,the purpose of this study is to establish a set of perfect perioperative management and out-of-hospital guidance program in THA.II.To explore the influence of various factors on unplanned readmission within30 days after total hip arthroplasty by analyzing a variety of controllable factors in perioperative period of THA,so as to provide a basis for accelerating the recovery of patients,reducing the burden of patients,reducing the rate of clinical readmission and reducing the waste of medical resources.Method:I.After the examination and approval of the ethics committee of our hospital,we admitted to the hospital from February 2018 to July 2019,and the first unilateral THA was performed in the people’s Hospital of Guangxi Autonomous region,and the patients who met the admission criteria were included in the enhanced recovery after surgery group(ERAS group).A total of 111 patients were prospectively observed.According to the inclusion and exclusion criteria of patients,the data of 104 patients who underwent the first unilateral THA in the people’s Hospital of Guangxi Autonomous region from June 2016 to January2018 were collected as the control group.The ERAS group adopted the perioperative management combined with out-of-hospital guidance strategy under the guidance of the concept of enhanced recovery after surgery,while the control group adopted the traditional treatment plan.Follow-up for 3 months,the perioperative indexes of the two groups included patient characteristics,preoperative complications,ASA,operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative drainage and drainage time,postoperative complications,preoperative and postoperative hip joint function(Harris score),preoperative and postoperative pain(VAS score),hospital stay and postoperative blood transfusion etc.Other observation indicators:hospitalization costs,patient satisfaction and unplanned readmission within 30 days.II.The data of 917 patients who underwent the first unilateral THA in the people’s Hospital of Guangxi Autonomous region from January 2013 to January2019 were collected.According to the inclusion criteria,exclusion criteria and integrity of the data,a total of 888 cases were excluded,and a total of 29 patients were obtained as the readmission group.Then,according to the matching principle in the codefinition,the matching was carried out according to the proportion of 1:2.Finally,58 patients who underwent the first unilateral THA in the people’s Hospital of Guangxi Autonomous region were selected from the readmission group.58 cases were included in the matching group.The observation indexes were the characteristics of the two groups,preoperative complications,operation time,hospital stay,intraoperative blood transfusion,postoperative blood transfusion and perioperative intervention etc.Result:I.The strategy of enhanced recovery after surgery was applied to the study of total hip arthroplasty.The results showed that the average intraoperative blood loss,postoperative blood transfusion,postoperative drainage time,average hospital stay and average hospitalization cost in the ERAS group were lower than those in the control group(76.23 ml,0.16 U,1.06 d,1.27 d and 2300 yuan,respectively).The intraoperative blood transfusion rates of the ERAS group and the control group were 1.8% and 8.6% respectively,the postoperative blood transfusion rates were 13.46% and 5.4% respectively,the total postoperative complication rates were 9.0% and 18.26% respectively,and the patient satisfaction was 94.59% and 81.73% respectively(P < 0.05).In comparison between the two groups,the VAS scores of pain on the 1st day,the first visit and the day of discharge were lower than those before operation,and the Harris scores of hip joint function in the second week,the first month and the third month after operation were higher than those before operation.In comparison between the two groups,the postoperative VAS scores of postoperative pain in the ERAS group were lower than those in the control group on the 1st day,the first time after operation and the day of discharge.The difference was the most significant in the first time after operation,and the difference was the smallest on the first day after operation.The Harris score of postoperative hip joint function in the ERAS group was higher than that in the control group at the 2nd week,the first month and the third month after operation.The difference was the most obvious in the first month and the smallest in the third month after operation.The above differences were statistically significant(P < 0.05).The operation time of ERAS group and control group was 144.62 ±26.96 min and143.10+29.80 min,respectively,and the readmission rate within 30 days after operation was 1.80% and 1.92%,respectively,and there was no significant difference between the two groups(P > 0.05).II.In the analysis of the factors affecting the unplanned readmission within 30 days after total hip arthroplasty,the results suggest that the main causes of unplanned readmission within 30 days after THA include joint dislocation(6,20.69%),infection(6,20.69%),periprosthetic fracture(6,10.34%),prosthesis loosening(3,10.34%),acute pain(3,10.34%)and poor wound healing(2,6.90%).In univariate analysis,there were significant differences in lung disease,mode of anesthesia,operation time,intraoperative blood transfusion,postoperative drainage time,hospital stay,postoperative anticoagulation regimen,postoperative hypoproteinemia and postoperative blood transfusion between patients in the readmission group and patients in the matching group(P < 0.05).In Logistic regression analysis,there was a statistically significant difference between the two groups of THA patients in intraoperative allogeneic blood transfusion(OR,3.975 [95%CI 1.006-15.71];P = 0.049)and postoperative hypoproteinemia(OR,3.486 [95% CI 1.048-11.593];P = 0.042).Conclusion:I.Enhanced recovery after surgery strategy is safe and effective in THA.It can reduce hospitalization time and cost,accelerate hip functional rehabilitation and improve patient satisfaction,but it has no significant effect on unplanned readmission of THA patients within 30 days after operation.II.Intraoperative allogeneic blood transfusion and postoperative hypoproteinemia are independent risk factors for unplanned readmission in patients with THA within 30 days after operation.In this study,the unplanned readmission rate within 30 days after total hip arthroplasty was 3.16%(290/917).The main reasons for readmission were joint dislocation,infection and periprosthetic fracture.