Avaliação da segurança da alta precoce após a artroplastia total do joelho
Data
2022-10-10
Autores
Figueiredo, Fernando Caetano Soares 
Orientadores
Tamaoki, Marcel Jun Sugawara
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: a artroplastia total do joelho (ATJ) tem-se mostrado um procedimento seguro e custo-efetivo - principalmente nos últimos 20 anos, após a introdução de protocolos de reabilitação acelerada. Tais protocolos - através da otimização de fluxos e práticas clínicas - proporcionaram melhores resultados e menor tempo de permanência hospitalar, com redução de custos sem aumento de complicações, demonstrados em estudos estrangeiros. No entanto, não foram, até a presente data, produzidos dados no Brasil. Objetivo: avaliar a segurança da alta precoce após o procedimento de ATJ no Brasil. Método: foi selecionada retrospectivamente uma série de casos consecutivos de artroplastias totais primárias e unilaterais, realizadas em hospital de referência em cirurgia do joelho na cidade de São Paulo, Brasil, no período de: dezembro de 2018 a julho de 2019; e que receberam alta anteriormente ao término do dia seguinte ao procedimento. Foram analisados dados demográficos, comorbidades, tempos cirúrgico e de internação, e observada a ocorrência de complicações nos primeiros 30 dias pós-operatórios. Resultados: no período foram realizadas 371 ATJs e incluídos no estudo 283 indivíduos. A idade média e desvio-padrão foram de 72,14 anos +/- 7,20, sendo 79,50% dos pacientes do sexo feminino. O índice de massa corpórea (IMC) ≥ 30 Kg/m2 foi encontrado em 49,46% dos casos; diabetes mellitus em 31,44%; e 91,74% obtiveram classificação de risco cirúrgico da Sociedade Americana de Anestesiologistas (ASA) grau 2. Complicações maiores foram observadas em 1,41% - especificamente uma ocorrência de tromboembolismo pulmonar (TEP) e 3 casos de infecção profunda. Complicações menores (incluindo dor com necessidade de pronto-atendimento) foram encontradas em 19,78% dos casos e 24,73% de todos os casos necessitaram de atendimento não planejado. Conclusão: A alta precoce após a ATJ, considerando-se a ocorrência de complicações maiores, é segura.
Palavras-chave: Artroplastia total do joelho; Artroplastia de substituição do joelho; Alta hospitalar; Tempo de internação; Complicações pós-operatórias.
Introduction: total knee replacement (TKR) has been considered to be a safe and cost-effective procedure - especially in the last twenty years, after the implementation of enhanced recovery protocols. Those protocols aim at enhancing clinical practices, with the goal of decreasing complications and length of stay, after TKRs – a well demonstrated fact in international studies. However no data has been produced to date in Brazil. Another benefit is the reduction of health care costs. Objectives: this study was conducted to evaluate whether or not it is safe to adopt early discharge (considered to be discharge that occurs before the end of the first postoperative day) after TKR. Methods: a series of patients that underwent primary unilateral total knee arthroplasties was retrospectively selected. TKRs were performed at a knee surgery private hospital in São Paulo, Brazil, from december of 2018 to january of 2019. All patients having received hospital discharge before the end of the first postoperative day. Were analyzed: individual demographics data, prevalence of comorbidities, surgical time as well as length of stay, and observed incidences of 30-days complications were compared to the published literature. Results: were analyzed the 283 individuals who underwent primary unilateral total knee arthroplasty. The mean age and standard deviation of the patients were 72,14 years old +/- 7,20 and 79,50% of the patients were females, Obesity - a body mass index ≥ 30 Kg/m2 - was encountered in 49,46% of cases; 31,44% of the patients had diabetes; and 91,74% were graded as “class 2” on the American Society of Anesthesiologists (ASA) classification system. Major complications were observed in 1,41% of individuals, being 1 case of pulmonary embolism and 3 cases of deep infection. Minor complications were observed in 19,78% - including cases of pain that needed urgent medical care - and 24,73% of all cases needed unplanned visits to a healthcare facility. Conclusion: Considering the incidence of major complications, the current enhanced recovery protocol was considered to be safe. Keywords: Total knee arthroplasty; Total knee replacement; Hospital discharge; Length of stay; Postoperative complications.
Introduction: total knee replacement (TKR) has been considered to be a safe and cost-effective procedure - especially in the last twenty years, after the implementation of enhanced recovery protocols. Those protocols aim at enhancing clinical practices, with the goal of decreasing complications and length of stay, after TKRs – a well demonstrated fact in international studies. However no data has been produced to date in Brazil. Another benefit is the reduction of health care costs. Objectives: this study was conducted to evaluate whether or not it is safe to adopt early discharge (considered to be discharge that occurs before the end of the first postoperative day) after TKR. Methods: a series of patients that underwent primary unilateral total knee arthroplasties was retrospectively selected. TKRs were performed at a knee surgery private hospital in São Paulo, Brazil, from december of 2018 to january of 2019. All patients having received hospital discharge before the end of the first postoperative day. Were analyzed: individual demographics data, prevalence of comorbidities, surgical time as well as length of stay, and observed incidences of 30-days complications were compared to the published literature. Results: were analyzed the 283 individuals who underwent primary unilateral total knee arthroplasty. The mean age and standard deviation of the patients were 72,14 years old +/- 7,20 and 79,50% of the patients were females, Obesity - a body mass index ≥ 30 Kg/m2 - was encountered in 49,46% of cases; 31,44% of the patients had diabetes; and 91,74% were graded as “class 2” on the American Society of Anesthesiologists (ASA) classification system. Major complications were observed in 1,41% of individuals, being 1 case of pulmonary embolism and 3 cases of deep infection. Minor complications were observed in 19,78% - including cases of pain that needed urgent medical care - and 24,73% of all cases needed unplanned visits to a healthcare facility. Conclusion: Considering the incidence of major complications, the current enhanced recovery protocol was considered to be safe. Keywords: Total knee arthroplasty; Total knee replacement; Hospital discharge; Length of stay; Postoperative complications.