全髋关节置换术患者延迟出院的危险因素分析

目的分析全髋关节置换术患者延迟出院的危险因素。方法回顾性分析2015年1月至2018年7月择期行单侧全髋关节置换术患者的临床资料,包括性别、年龄、BMI、ASA分级、手术时间、麻醉方式、术中失血量、术中输液量、术中阿片类药物用量、术中血管活性药物用量、PACU停留时间、术后随访静息疼痛评分、术前住院时间、术前合并症、术后并发症及转归情况。根据术后住院时间将患者分为两组:正常出院组(术后住院时间≤14 d)和延迟出院组(术后住院时间>14 d),采用单因素和多因素Logistic回归分析影响延迟出院的因素。结果共纳入908例患者。单因素分析显示,与正常出院组比较,延迟出院组的年龄明显偏高,术中失血量明显增多,手术时间、PACU停留时间、术前住院时间明显延长,术前合并症、术后并发症明显增多(P<0.05)。Logistic回归分析显示,年龄≥70岁(OR=2.075,95%CI 1.287~3.346,P=0.003)、手术时间>3 h(OR=1.997,95%CI 1.181~3.375,P=0.010)、术中失血量≥800 ml(OR=2.898,95%CI 1.449~5.794,P=0.003)、PACU时间>60 min(OR=1.745,95%CI 1.064~2.859,P=0.027)、术前住院时间≥7 d(OR=1.805,95%CI 1.114~2.924,P=0.016)、术前有合并症≥2个(OR=2.912,95%CI 1.513~5.825,P=0.003)是导致患者延迟出院的独立危险因素。结论患者年龄、术中失血量、手术时间、PACU停留时间、术前住院时间及术前合并症是全髋关节置换术后出院延迟的独立危险因素,针对危险因素进行有效干预是缩短住院时间改善患者预后的重要策略。

Risk factors for delayed hospital discharge in patients undergoing total hip joint replacement surgery

Objective To identify the risk factors for delayed hospital discharge in patients undergoing total hip joint replacement surgery. Methods The data of the patients scheduled for elective total hip joint replacement surgery in Tongji Hospital from January 2015 to July 2018 were retrospectively collected. Potential risk factors including sex, age, BMI, ASA physical status, duration of surgery, type of anesthesia, blood loss, volume replacement, opioid used, vasoactive agents, and duration of PACU, first postoperative resting pain score, waiting time to operation, preoperative comorbidities, postoperative complications and admission to ICU, were analyzed by the Chi-square test and Kruskal-Wallis H test. Binary logistic regression was performed to identify the independent risk factors on the basis of postoperative hospital stay(categorically defined as ≤14 days and >14 days). Results A total of 908 patients were included in the study. Univariate analysis demonstrated that age, intraoperative blood loss, duration of surgery and PACU, waiting time to operation, preoperative comorbidities and postoperative complications were associated with prolonged length of stay after operation(P < 0.05). Binary logistic regression analysis showed that age ≥70 years(OR = 2.075, 95%CI 1.287-3.346, P = 0.003), intraoperative blood loss ≥800 ml(OR = 2.898, 95%CI 1.449-5.794, P = 0.003), duration of surgery >3 hours(OR=1.997, 95%CI 1.181-3.375, P = 0.010), duration of PACU >60 minutes(OR = 1.745, 95%CI 1.064-2.859, P = 0.027), waiting time to operation ≥7 days(OR = 1.805, 95%CI 1.114-2.924, P = 0.016) and preoperative comorbidities(OR = 2.912, 95%CI 1.513-5.825, P = 0.003) were independent risk factors for delayed hospital discharge. Conclusion Age, intraoperative blood loss, duration of surgery and PACU, waiting time to operation and preoperative comorbidities were independent risk factors for delayed hospital discharge in patients undergoing total hip replacement surgery.