Outpatient total hip or knee arthroplasty in ambulatory surgery center versus arthroplasty ward: a randomized controlled trial

Christian Husted, Kirill Gromov, Helle Krogshøj Hansen, Anders Troelsen, Billy B Kristensen, Henrik Husted, Christian Husted, Kirill Gromov, Helle Krogshøj Hansen, Anders Troelsen, Billy B Kristensen, Henrik Husted

Abstract

Background and purpose - Discharge on the day of surgery (DOS) in selected patients operated with total hip arthroplasty (THA) or total knee arthroplasty (TKA) has been shown to be feasible, but different factors may determine whether patients are discharged on the DOS or not and setting may be one of them. We investigated the importance of the setting in which the short stay following outpatient THA or TKA takes place: was there a difference between the proportion of patients being discharged on the DOS from an ambulatory surgery center (ASC) compared with patients staying on an arthroplasty ward?Patients and methods - 50 patients (30 TKA, 20 THA) were included in the study and postoperatively randomized to either staying in the ASC or the arthroplasty ward until discharge. All patients were operated under general anesthesia by the same experienced surgeon (HH) and were discharged upon fulfillment of standardized discharge criteria.Results - 24/25 of the patients who stayed in the ASC compared with 20/25 of the patients on the arthroplasty ward were discharged on the DOS following fulfillment of discharge criteria (p = 0.08). All THA patients were discharged on the DOS and significantly more TKA patients were discharged from the ASC (15/16) vs. from the ward (9/14) (p = 0.04).Interpretation - Despite fixed discharge criteria, the logistical setting may play a role for achieving discharge on DOS and the ASC may facilitate achieving discharge criteria earlier especially in TKA.

Figures

Figure 1.
Figure 1.
Flow chart of included THA patients.
Figure 2.
Figure 2.
Flow chart of included TKA patients.

References

    1. Andersen L Ø, Gaarn-Larsen L, Kristensen B B, Husted H, Otte K S, Kehlet H. Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 2009; 64(5): 508–13.
    1. Andreasen S E, Holm H B, Jørgensen M, Gromov K, Kjaersgaard-Andersen P, Husted H. Time-driven activity-based cost of fast-track total hip and knee arthroplasty. J Arthroplasty 2017; 32(6): 1747–55.
    1. Argenson J N, Husted H, Lombardi A Jr, 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. Berger R A, Kusuma S K, Sanders S A, Thill E S, Sporer S M. The feasibility and perioperative complications of outpatient knee arthroplasty. Clin Orthop Relat Res 2009; 467(6): 1443–9.
    1. Boylan M R, Perfetti D C, Naziri Q, Maheshwari A V, Paulino C B, Mont M A. Is day of surgery associated with adverse clinical and economic outcomes following primary total knee arthroplasty? J Arthroplasty 2017; 32(8): 2339–2346.
    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. Crawford D A, Adams J B, Berend K R, Lombardi A V Jr.. Low complication rates in outpatient total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; May 18 [Epub ahead of print].
    1. DeCook C A. Outpatient joint arthroplasty: transitioning to the ambulatory surgery center. J Arthroplasty 2019; 34(7S): S48–S50.
    1. Fransen B L, Hoozemans M J M, Argelo K D S, Keijser L C M, Burger B J. Fast-track total knee arthroplasty improved clinical and functional outcome in the first 7 days after surgery: a randomized controlled pilot study with 5-year follow-up. Arch Orthop Trauma Surg 2018; 138(9): 1305–16.
    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. Gromov K, Kjaersgaard-Andersen P, Revald P, Kehlet H, Husted H. Feasibility of outpatient total hip and knee arthroplasty in unselected patients. Acta Orthop 2017; 88(5): 516–21.
    1. Gromov K, Jørgensen C C, Petersen P B, Kjaersgaard-Andersen P, Revald P, Troelsen A, Kehlet H, Husted H. Complications and readmissions following outpatient total hip and knee arthroplasty: a prospective 2-center study with matched controls. Acta Orthop 2019; 90(3): 281–5.
    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. Husted H. Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop Suppl 2012; 83(346): 1–39.
    1. Husted H, Holm G. Fast track in total hip and knee arthroplasty: experiences from Hvidovre University Hospital, Denmark. Injury 2006; 37 (Suppl. 5):S31–S5.
    1. Husted H, Otte K S, Kristensen B B, Ørsnes T, Wong C, Kehlet H. Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 2010; 81(5): 599–605.
    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, Kristensen B B, Andreasen S E, Skovgaard Nielsen C, Troelsen A, Gromov K. Time-driven activity-based cost of outpatient total hip and knee arthroplasty in different set-ups. Acta Orthop 2018; 89(5): 515–21.
    1. Jørgensen C C, Kehlet H; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative group. Early thromboembolic events ≤ 1week after fast-track total hip and knee arthroplasty. Thromb Res 2016; 138: 37–42.
    1. Jørgensen C C, Kehlet H; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative group. Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty. Acta Anaesthesiol Scand 2017; 61(4): 436–44.
    1. Keswani A, Beck C, Meier K M, Fields A, Bronson M J, Moucha C S. Day of surgery and surgical start time affect hospital length of stay after total hip arthroplasty. J Arthroplasty 2016; 31(11): 2426–31.
    1. Klapwijk L C, Mathijssen NM, Van Egmond J C, Verbeek B M, Vehmeijer S B. The first 6 weeks of recovery after primary total hip arthroplasty with fast track. Acta Orthop 2017; 88(2): 140–4.
    1. Lunn T H, Kristensen B B, Gaarn-Larsen L, Husted H, Kehlet H. Post-anaesthesia care unit stay after total hip and knee arthroplasty under spinal anaesthesia. Acta Anaesthesiol Scand 2012; 56(9): 1139–45.
    1. Oosterholt R I, Simonse L W, Boess S U, Vehmeijer S B. Designing a care pathway model: a case study of the outpatient total hip arthroplasty care pathway. Int J Integr Care 2017; 17(1): 2.
    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. Porsius J T, Mathijssen N M C, Klapwijk-Van Heijningen L C M, Van Egmond J C, Melles M, Vehmeijer S B W. Early recovery trajectories after fast-track primary total hip arthroplasty: the role of patient characteristics. Acta Orthop 2018; 89(6): 597–602.
    1. Vehmeijer S B W, Husted H, Kehlet H. Outpatient total hip and knee arthroplasty. Acta Orthop 2018; 89(2): 141–4.

Source: PubMed

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