| Sumario: | Introduction The clinical demand for joint replacement surgery is increasing. While the outpatient surgery model offers significant advantages, its processes still need optimization. Robot-assisted minimally invasive technology supports the improvement of surgical safety and efficiency. This study explores the application value and medium- to long-term efficacy of optimized processes through a multicenter controlled trial. Aim To optimize the day surgery process of robot-assisted minimally invasive total knee arthroplasty (TKA) and total hip arthroplasty (THA), and to verify their safety, efficacy, and medium- and long-term clinical efficacy. Methods A total of 682 patients who underwent robot-assisted minimally invasive TKA/THA from 8 tertiary hospitals in the province from January 2020 to June 2022 were enrolled, and were divided into optimized day surgery group (345 cases, 189 cases TKA, 156 cases) and traditional inpatient surgery group (337 cases, 182 cases TKA, 155 cases THA) according to the operation mode. The day group adopted the optimization process of "preoperative precise assessment-robotic minimally invasive operation-ERAS multimodal analgesia-closed- loop management of discharge", while the control group adopted the routine inpatient diagnosis and treatment process. The follow-up was 24 months, and the perioperative indexes, complication rate, joint function score and readmission rate were compared between the two groups. Results There was no significant difference in the mean operation time (TKA 82.3±11.5 min, THA 76.8±9.7 min) between the day group and the control group (P>0.05), but the intraoperative blood loss (TKA 85.6±20.3 ml, THA 92.4±22.1 ml) was significantly lower than that in the control group (P<0.01), and the average hospital stay time (12.8±3.5h vs 4.2±1.3d) and the time to get out of bed after operation (6.2±1.8h vs 24.5±5.7h) were significantly shortened (P). ><0.01.The total incidence of complications at 24 months after surgery in the day group was 2.3% (8/345), which was significantly lower than that in the control group (6.8% (23/337) (P><0.05), mainly incisional exudate (1.2%), transient joint swelling (1.1%), and no serious thrombosis or infection events. There was no significant difference in KSS knee score (TKA: 89.6±4.2 vs 88.3±4.7) and Harris hip score (THA: 90.2±3.8 vs 89.5±4.1) at 24 months after surgery (P>0.05), and the readmission rate was 1.5% (5/345) in the day group and 1.8% (6/337) (P> in the control group 0.05. Conclusion The optimized robot-assisted minimally invasive TKA/ THA day surgery process is safe and feasible, can reduce intraoperative bleeding, shorten the hospitalization period, and the medium and long-term efficacy is comparable to that of traditional inpatient surgery, which provides an evidence-based basis for the standardized promotion of joint replacement day surgery.
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