RÉSUMÉ
BACKGROUND: Multiple papers have purported the superiority of spinal anesthesia used in total joint arthroplasty (TJA). However, there is a paucity of data available for modern general anesthesia (GA) regimens used at high-volume joint replacement centers. METHODS: We retrospectively reviewed a series of 1527 consecutive primary TJAs (644 total hip arthroplasties and 883 total knee arthroplasties) performed over a 3-year span at a single institution that uses a contemporary GA protocol and report on the length of stay, early recovery rates, perioperative complications, and readmissions. RESULTS: From the elective TJAs performed using a modern GA protocol, 96.3% (n = 1471) of patients discharged on postoperative day 1, and 97.2% (n = 1482) of subjects were able to participate with physical therapy on the day of surgery. Only 6 patients (0.4%) required an intensive care unit stay postoperatively. The 90-day readmission rate over this time was 2.4% (n = 36), while the reoperation rate was 1.3% (n = 20). DISCUSSION: Neuraxial anesthesia for TJA is commonly preferred in high-volume institutions utilizing contemporary enhanced recovery pathways. Our data support the notion that the utilization of modern GA techniques that limit narcotics and certain inhalants can be successfully used in short-stay primary total joint arthroplasty. LEVEL OF EVIDENCE: IV- Case series.
Sujet(s)
Anesthésie générale/effets indésirables , Arthroplastie prothétique de hanche/statistiques et données numériques , Arthroplastie prothétique de genou/statistiques et données numériques , Sortie du patient/statistiques et données numériques , Complications postopératoires/épidémiologie , Sujet âgé , Anesthésie générale/méthodes , Arkansas/épidémiologie , Arthroplastie prothétique de hanche/effets indésirables , Arthroplastie prothétique de hanche/rééducation et réadaptation , Arthroplastie prothétique de genou/effets indésirables , Arthroplastie prothétique de genou/rééducation et réadaptation , Interventions chirurgicales non urgentes , Récupération améliorée après chirurgie , Femelle , Humains , Durée du séjour/statistiques et données numériques , Mâle , Adulte d'âge moyen , Réadmission du patient/statistiques et données numériques , Complications postopératoires/étiologie , Réintervention/statistiques et données numériques , Études rétrospectives , Facteurs tempsRÉSUMÉ
Two infants with congenital hypoplastic anemia had an unusual number of lymphocytes in their peripheral blood and in the bone marrow. This caused an erroneous diagnosis of acute lymphocytic leukemia to be made in the first case and inappropriate therapy to be administered for three months. The second of these cases provided an unusual opportunity to study human erythrocyte precursor dynamics. Serial bone marrow aspirates, obtained after institution of treatment with a corticosteroid, revealed an initial increase in labeled lymphocytes, a concomitant decrease in their number, and the subsequent appearance of erythroid elements. These findings suggest that cells classified morphologically as lymphocytes may serve as erythroid precursors in human beings.