A Comparative Study Of Knee Arthroscopic Day Surgery Mode And Traditional Hospitalization Mode Based On Enhanced Recovery After Surgery

Background In recent years,day surgery has been vigorously promoted by the country,and it has played an important role in improving the efficiency of hospital bed turnover and alleviating the unpleasant and expensive medical treatment of the people,However,perioperative complications still affect its rapid development.And accelerated postoperative rehabilitation surgery is a mature perioperative optimization strategy,which has been widely used in clinical practice.Objective To provide the optimal diagnosis and treatment mode for knee arthroscopic,through a comparative study of the day surgery mode and the traditional inpatient surgery mode based on enhanced recovery after surgery.Methods One hundred of both sexes,aged 18～65 years of ASA physical status Ⅰ～Ⅱ,undergoing elective unilateral arthroscopic meniscus resection or plastic surgery or examination,normal cognitive function,approved by the medical ethics committee of hospital and provided informed consent.According to the different hospitalization mode,subjects were divided into 2 groups(n = 50 each)using a random number table: Group D:day surgery hospitalization mode group,which admission,operation and discharge were completed within24 h;Group H:traditional hospitalization mode group,which preoperative preparation was done after admission,then the operation was performed,discharging after totally recovery.The venous blood sample were collected to detect the serum levels of interleukin-6,blood sugar and insulin in the two groups respectively,and calculate the incidence of insulin resistance at 30 min before operation and 2 h after operation respectively.Mean arterial pressure(MAP)and heart rate(HR)were recorded when entering the room,after induction of anesthesia,skin incision,and before leaving the room.Operating time,intraoperative blood loss and fluid infusion were recorded;the total consumption of propofol,sufentanil and remifentanil during the operation were recorded After extubation,3 h,6 h,12 h,24 h after surgery,static and dynamic pain visual analog scale scores were recorded,respectively;the time required for the postoperative knee joint mobility to recover to 30°,60°,90°,120° were recorded;the postoperative water intaking time,the first time to get out of bed,drainage tube removing time,hospital stay,hospitalization expenses were recorded.Incidences of postoperta-tive wound bleeding,infection and patient satisfaction were calculated.Results(1)There was no significant difference in general conditions between the two groups of patients(P > 0.05).(2)Compared with when entering the room,both MAP and HR were decreased significantly after induction of anesthesia,during skin incision,and when leaving the room in both groups(P < 0.05).(3)Compared with group H,the level of serum IL-6 was decreased at 2 h after operation in group D(P < 0.05).Compared with preoperative serum IL-6,they were decreased at 2 h after surgery in both groups(P < 0.05).(4)Intraoperative sufentanil,remifentanil and propofol dosages were not significantly different between the two groups(P > 0.05).(5)There were no significant differences about postoperative resting and movement pain visual analog scale scores at different time points between the two groups(P > 0.05).Compared with after extubation,the resting and movement visual analog scale scores were increased at 6h,12 h,24h after surgery in the two groups(P < 0.05).(6)There were no significant differences about the muscle strength grades at different time points between the two groups(P > 0.05).Compared with immediately after surgery,the muscle strength grades were increased at 3h,6h,12 h,24h after surgery(P < 0.05).(7)Compared with group H,it takes shorter time to recover joint activity of 30°,60°,90°,120° after surgery in group D(P < 0.05).Compared with the postoperative joint activity recovery of 30°,it takes longer to recover the joint activity of 60°,90°,and 120° in both groups(P <0.05).(8)Compared with group H,it takes shorter time to get out of bed for the first time after operation and to remove drainage tube in group D(P < 0.05).Compared with group H,there were shorter hospital stay and lower medical cost in group D(P < 0.05).There were no significant differences about postoperative analgesia salvage rate and complication rate between the two groups(P > 0.05).Compared with group H,patients are more satisfied for the medical service in group D(P < 0.05).Conclusion(1)Based on the concept of enhenced recovery after surgery,it is safe and feasible to perform knee arthroscopic meniscus resection/plasty/inspection surgery with both day surgery mode and traditional inpatient surgery mode;(2)And compared with the traditional inpatient surgery mode,it is more suitable for knee arthroscopic meniscus resection/plasty/check surgery with day surgery mode.