Expert consensus on perioperative management of day surgery for hip and knee arthroplasty in China

doi:10.3877/cma.j.issn.2096-0263.2023.06.001

Abstract

Abstract:

Day Surgery, also known as Ambulatory surgery, refers to surgical procedures in which patients are admitted and discharged within 24 hours. In special cases where hospitalization is required, the stay should not exceed 48 hours. The implementation of day surgery offers several advantages, including shorter hospital stays, reduced treatment costs, improved treatment quality, enhanced patient satisfaction, and more efficient allocation of medical resources by hospitals. With the development of surgical techniques, anesthetic technique, and Enhanced Recovery After Surgery (ERAS) protocols, China is now equipped to perform hip and knee joint arthroplasty as day surgeries. This consensus has been formed by reviewing the literature, summarizing successful experiences, following evidence-based medicine principles, and undergoing extensive discussions, editing, and organization by national experts. It is intended to serve as a reference for orthopedic surgeons in their clinical practice. This consensus comprises four main sections: the day surgery implementation model, team building, outpatient screening, perioperative management, post-discharge follow-up, and day surgery quality assessment.

Key words: Day Surgery, Hip, Knee joint, Joint Arthroplasty, Enhanced Recovery after Surgery, Perioperative Management

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References 89

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证据质量分级	定义
高（A）	非常有把握观察值接近真实值
中（B）	对观察值有中等把握，观察值有可能接近真实值，但也有可能差别更大
低（C）	对观察值的把握有限：观察值可能与真实值有很大差别
极低（D）	对观察值几乎没有把握：观察值和真实值可能有极大差别

证据质量分级	定义
高（A）	非常有把握观察值接近真实值
中（B）	对观察值有中等把握，观察值有可能接近真实值，但也有可能差别更大
低（C）	对观察值的把握有限：观察值可能与真实值有很大差别
极低（D）	对观察值几乎没有把握：观察值和真实值可能有极大差别

推荐强度分级	定义
强推荐（1）	明显显示干预措施利大于弊
弱推荐（2）	利弊不确定或干预措施可能利大于弊
专家建议（good practic statement，GPS）	基于非直接证据或专家意见、经验形成的推荐

推荐强度分级	定义
强推荐（1）	明显显示干预措施利大于弊
弱推荐（2）	利弊不确定或干预措施可能利大于弊
专家建议（good practic statement，GPS）	基于非直接证据或专家意见、经验形成的推荐

纳入标准	排除标准
	1.BMI≥30 kg/m²
	2.精神疾病（如抑郁）或认知、沟通障碍
	3.术前出现全身或局部感染征象
	4.术后尿潴留病史，难控的良性前列腺增生，需要长期导尿
1.患者理解相关治疗过程，具有知情同意的能力	5.对拟选用的预防感染或镇痛等药物过敏
2.建议年龄在18~75岁之间	6.过去一年内发生肺栓塞或深静脉血栓形成
3.ASA Ⅰ~Ⅱ级	7.长期服用抗凝药、糖皮质激素类药物者
4.膝关节单髁置换，或单侧人工全髋、人工全膝关节置换，人工髋膝关节简单翻修手术，手术时间<2 h	8.全身性疾病（糖尿病、心脏病、肝硬化、肾病、贫血等）需要特殊的围手术期护理（重症监护、多次输血、透析等）
5.手术当天有家属陪同患者入院，并在术后具备家庭或基层医疗机构的陪护条件	9.凝血障碍增加术中和术后出血的风险（血小板减少症、血友病等）
5.手术当天有家属陪同患者入院，并在术后具备家庭或基层医疗机构的陪护条件	10.除要置换的关节之外的运动问题，如肌力不足、对侧肢体疾病等
6.能够配合术后随访	11.神经障碍（如老年痴呆）或平衡障碍
	12.肺部高危因素：合并哮喘、慢阻肺、睡眠呼吸暂停综合征
	13.家庭条件差，无法实现家庭护理，并（或）无法进行基层医疗机构的康复治疗
	14.经麻醉评估不合格者
	15.无法接受日间手术流程及围手术期处理策略

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