Feasibility of outpatient total hip and knee arthroplasty in unselected patients

Kirill Gromov, Per Kjærsgaard-Andersen, Peter Revald, Henrik Kehlet, Henrik Husted, Kirill Gromov, Per Kjærsgaard-Andersen, Peter Revald, Henrik Kehlet, Henrik Husted

Abstract

Background and purpose - The number of patients who are suitable for outpatient total hip and knee arthroplasty (THA and TKA) in an unselected patient population remains unknown. The purpose of this prospective 2-center study was to identify the number of patients suitable for outpatient THA and TKA in an unselected patient population, to investigate the proportion of patients who were discharged on the day of surgery (DOS), and to identify reasons for not being discharged on the DOS. Patients and methods - All consecutive, unselected patients who were referred to 2 participating centers and who were scheduled for primary THA and TKA were screened for eligibility for outpatient surgery with discharge to home on DOS. If patients did not fulfill the discharge criteria, the reasons preventing discharge were noted. Odds factors with relative risk intervals for not being discharged on DOS were identified while adjusting for age, sex, ASA score, BMI and distance to home. Results - Of the 557 patients who were referred to the participating surgeons during the study period, 54% were potentially eligible for outpatient surgery. Actual DOS discharge occurred in 13-15% of the 557 patients. Female sex and surgery late in the day increased the odds of not being discharged on the DOS. Interpretation - This study shows that even in unselected THA and TKA patients, same-day discharge is feasible in about 15% of patients. Future studies should evaluate safety aspects and economic benefits.

Figures

Figure 1.
Figure 1.
Flow chart for inclusion of TKA patients for same-day (SD) discharge. a Language problems (1), low compliance (4), living at a nursing home (1), and unknown (1).
Figure 2.
Figure 2.
Flow chart for inclusion of THA patients for same-day (SD) discharge. a Chronic pain (1), cancer (1), low compliance (3), and unknown (2).

References

    1. Andersen L Ø, Kehlet H.. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth 2014; 113(3): 360–74.
    1. Argenson J-N A, Husted H, Lombardi A, Booth R E, Thienpont E.. Global forum: An international perspective on outpatient surgical procedures for adult hip and knee reconstruction. J Bone Joint Surg Am 2016; 98(13): e55.
    1. Aynardi M, Post Z, Ong A, Orozco F, Sukin D C.. Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J 2014; 10(3): 252–5.
    1. Berger R A. A comprehensive approach to outpatient total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2007; 36(9 Suppl): 4–5.
    1. Berger R A, Sanders S, Gerlinger T, Della Valle C, Jacobs J J, Rosenberg A G.. Outpatient total knee arthroplasty with a minimally invasive technique. J Arthroplasty 2005; 20 (7 Suppl 3): 33–8.
    1. Berger R A, Sanders S A, Thill E S, Sporer S M, Della Valle C.. Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients. Clin Orthop Relat Res 2009; 467(6): 1424–30.
    1. Bertin K C. Minimally invasive outpatient total hip arthroplasty: a financial analysis. Clin Orthop Relat Res 2005; (435): 154–63.
    1. Chen D, Berger R A.. Outpatient minimally invasive total hip arthroplasty via a modified Watson-Jones approach: technique and results. Instr Course Lect 2013; 62: 229–36.
    1. Dorr L D, Thomas D J, Zhu J, Dastane M, Chao L, Long W T.. Outpatient total hip arthroplasty. J Arthroplasty 2010; 25(4): 501–6.
    1. Goyal N, Chen A F, Padgett S E, Tan T L, Kheir M M, Hopper R H, et al. . Otto Aufranc Award: A multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clin Orthop Relat Res 2017; 475(2): 364–72.
    1. Grant R L. Converting an odds ratio to a range of plausible relative risks for better communication of research findings. BMJ 2014; 348: f7450.
    1. Hartog Y M den, Mathijssen N M C, Vehmeijer S B W.. Total hip arthroplasty in an outpatient setting in 27 selected patients. Acta Orthop 2015; 86(6): 667–70.
    1. Hayes J H, Cleary R, Gillespie W J, Pinder I M, Sher J L.. Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplasty 2000; 15(4): 448–52.
    1. Healy W L, Iorio R, Ko J, Appleby D, Lemos D W.. Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Joint Surg Am 2002; 84-A(3): 348–53.
    1. Husted H. Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop 2012; 83 (Suppl 346): 1–39.
    1. Husted H, Lunn T H, Troelsen A, Gaarn-Larsen L, Kristensen B B, Kehlet H.. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop 2011; 82(6): 679–84.
    1. Husted H, Jørgensen CC, Gromov K, Kehlet H.. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty? Acta Orthop 2016; 87(5): 466–72.
    1. Jans Ø, Kehlet H.. Postoperative orthostatic intolerance: a common perioperative problem with few available solutions. Can J Anaesth 2017; 64(1): 10–15.
    1. Kehlet H. Fast-track hip and knee arthroplasty. Lancet 2013; 381(9878): 1600–2.
    1. Kolisek F R, McGrath M S, Jessup N M, Monesmith E A, Mont M A.. Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res 2009; 467(6): 1438–42.
    1. Kort N P, Bemelmans Y F L, van der Kuy P H M, Jansen J, Schotanus M G M.. Patient selection criteria for outpatient joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016. Apr 22; [Epub ahead of print]
    1. Lovald S, Ong K, Lau E, Joshi G, Kurtz S, Malkani A.. Patient selection in outpatient and short-stay total knee arthroplasty. J Surg Orthop Adv 2014a; 23(1): 2–8.
    1. Lovald S T, Ong K L, Malkani A L, Lau E C, Schmier J K, Kurtz S M, et al. . Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 2014b; 29(3): 510–5.
    1. Lovecchio F, Alvi H, Sahota S, Beal M, Manning D.. Is outpatient arthroplasty as safe as fast-track inpatient arthroplasty? A propensity score matched analysis. J Arthroplasty 2016; 31(9 Suppl): 197–201.
    1. Lunn T H, Kristensen B B, Andersen L Ø, Husted H, Otte K S, Gaarn-Larsen L, et al. . Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth 2011; 106(2): 230–8.
    1. Lunn T H, Andersen L O, Kristensen B B, Husted H, Gaarn-Larsen L, Bandholm T, et al. . Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Br J Anaesth 2013; 110(1): 66–73.
    1. Malviya A, Martin K, Harper I, Muller S D, Emmerson K P, Partington P F, et al. . Enhanced recovery program for hip and knee replacement reduces death rate. Acta Orthop 2011; 82(5): 577–81.
    1. Maradit Kremers H, Visscher S L, Kremers W K, Naessens J M, Lewallen D G.. Obesity increases length of stay and direct medical costs in total hip arthroplasty. Clin Orthop Relat Res 2014; 472(4): 1232–9.
    1. Mathijssen N M C, Verburg H, van Leeuwen C CG, Molenaar T L, Hannink G.. Factors influencing length of hospital stay after primary total knee arthroplasty in a fast-track setting. Knee Surg Sports Traumatol Arthrosc 2016; 24(8): 2692–6.
    1. Parcells B W, Giacobbe D, Macknet D, Smith A, Schottenfeld M, Harwood D A, et al. . Total joint arthroplasty in a stand-alone ambulatory surgical center: short-term outcomes. Orthopedics 2016; 39(4): 223–8.
    1. Parvizi J. CORR Insights(®): Otto Aufranc Award: A multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clin Orthop Relat Res 2017; 475(2): 373–4.
    1. Petis S M, Howard J L, Lanting B A, Somerville L E, Vasarhelyi E M.. Perioperative predictors of length of stay after total hip arthroplasty. J Arthroplasty 2016; 31(7): 1427–30.
    1. Rolighed Larsen J, Skovgaard B, Prynø T, Bendikas L, Mikkelsen L R, Laursen M, et al. . Feasibility of day-case total hip arthroplasty: a single-centre observational study. Hip Int 2017; 27(1): 60–5.
    1. Rozell J C, Courtney P M, Dattilo J R, Wu C H, Lee G C.. Late complications following elective primary total hip and knee arthroplasty: who, when, and how? J Arthroplasty 2017; 32(3): 719–23.
    1. Van Ryswyk E, Antic N.. Opioids and sleep disordered breathing. Chest 2016; 150(4): 934–44.
    1. Sibia U S, MacDonald J H, King P J.. Predictors of hospital length of stay in an enhanced recovery after surgery program for primary total hip arthroplasty. J Arthroplasty 2016; 31(10): 2119–23.

Source: PubMed

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