Day-case surgery for total hip and knee replacement

Lazic, Stefan; Boughton, Oliver; Kellett, Catherine F.; Kader, Deiary F.; Villet, Loïc; Rivière, Charles

doi:10.1302/2058-5241.3.170031

Cited by 44 publications

(33 citation statements)

References 65 publications

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“…The literature provides no standardized criteria that the patient must fulfill on the day of discharge following THA: each researcher devises a specific criterion believed to be the most appropriate for a given population [34]. In Poland, the mean time to rehabilitation is 109 days; therefore, in our case, the most important criteria were the period of time before independent functioning, and a VAS score below 3 successfully treated with the help of the first and second levels of the analgesic ladder.…”

Section: Discussionmentioning

confidence: 99%

“…In Poland, the mean time to rehabilitation is 109 days; therefore, in our case, the most important criteria were the period of time before independent functioning, and a VAS score below 3 successfully treated with the help of the first and second levels of the analgesic ladder. Our criteria were based on the works of Larsen and of Lazie [26,34]. Selected works demonstrate that shorter hospitalization after THA may yield a range of benefits for patients.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of clinical and economic outcomes between the direct anterior approach and the posterolateral approach for primary total hip arthroplasty

Skowronek

Dębiński²,

Maksymiuk-Kłos³

et al. 2020

Arch Med Sci

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Introduction: Total hip arthroplasty (THA) is one of the most frequently performed surgical procedures in orthopedics. The most commonly employed approaches are the posterolateral approach (PLA) and the lateral approach. Minimally invasive techniques such as direct anterior approach (DAA) and MIS DAA (minimal invasive surgery direct anterior approach) are used more and more often. The aim of the study was to compare the two approaches DAA and PLA in terms of length of stay, economic outcomes, quality of life, hip joint function and hip joint awareness. Material and methods: The study was performed as a retrospective analysis of 52 cementless total hip arthroplasty procedures performed by MIS DAA and 56 cementless THA performed by classic standard PLA. The evaluation of hip joint awareness, quality of life, hip joint fitness assessment and economic indicators were evaluated. Results: The mean duration of the anterior approach procedure (48.96 minutes) was found to be around half that of the posterior approach (102.52 minutes) (Levene's test: F = 2.37; p > 0.005). The mean durations of the two types of approaches were found to be significantly different (Student's t test: t (106) =-16.15; p < 0.005). The shorter mean duration of stay and shorter procedure duration associated with the anterior approach result in mean savings of PLN 5465.96 per procedure. Conclusions: The MIS DAA procedure is a safe and less traumatizing surgical approach for hip arthroplasty which allows faster post-operative primary mobilization, shorter procedure time and sooner discharge from hospital than standard PLA. Significant reduction in costs of hospitalization was observed in the MIS DAA procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of clinical and economic outcomes between the direct anterior approach and the posterolateral approach for primary total hip arthroplasty

Skowronek

Dębiński²,

Maksymiuk-Kłos³

et al. 2020

Arch Med Sci

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“…Unlike inpatient arthroplasty, where the maximum drop in Hb has been shown to be seen after four days, 35 there is no evidence in the literature to advocate the optimal timing for a Hb check following day-case THA. 36 Preoperatively, selecting patients with an adequate Hb can curtail the need for a blood transfusion, which in turn can increase LOS. Moreover, the use of tranexamic acid has proven to be an effective method of achieving haemostasis intra-operatively.…”

Section: Perioperative Measuresmentioning

confidence: 99%

Day-case total hip arthroplasty: a literature review and development of a hospital pathway

et al. 2021

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Aims We present the development of a day-case total hip arthroplasty (THA) pathway in a UK National Health Service institution in conjunction with an extensive evidence-based summary of the interventions used to achieve successful day-case THA to which the protocol is founded upon. Methods We performed a prospective audit of day-case THA in our institution as we reinitiate our full capacity elective services. In parallel, we performed a review of the literature reporting complication or readmission rates at ≥ 30-day postoperative following day-case THA. Electronic searches were performed using four databases from the date of inception to November 2020. Relevant studies were identified, data extracted, and qualitative synthesis performed. Results Our evaluation and critique of the evidence-based literature identifies day-case THA to be safe, effective, and economical, benefiting both patients and healthcare systems alike. We further validate this with our institutional elective day surgery arthroplasty pathway (EDSAP) and report a small cohort of successful day-case THA cases as an example in the early stages of this practice in our unit. Conclusion Careful patient selection and education, adequate perioperative considerations, including multimodal analgesia, surgical technique and blood loss management protocols and appropriate postoperative pathways comprising reliable discharge criteria are essential for successful day-case THA. Cite this article: Bone Jt Open 2021;2(2):93–102.

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“…For outpatient arthroplasty cases, care coordination and discharge planning that historically had occurred during inpatient admissions has to be conducted in the preoperative period to mitigate potential barriers for home discharge. Another component that is not accounted for in the reimbursement methodology is the need for close postoperative follow-up of patients discharged to home on the day of surgery [15,16]. For example, part of the success of outpatient TKA has been attributed to the utilization of nurse navigators who provide close communication and follow-up for patients [17].…”

Section: Financial Implicationsmentioning

confidence: 99%

Total Knee Arthroplasty in Ambulatory Surgery Centers: The New Reality!

2020

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By streamlining surgical care and eliminating postoperative hospitalization, the transition to ambulatory total knee arthroplasty (TKA) has the potential to improve efficiency and minimize the costs of care. However, practical, legal, and financial implications remain to be addressed. The Centers for Medicare and Medicaid Services has also yet to address concerns generated by the removal of TKA from the Inpatient-Only List and provide guidance on patient selection. Rolling out regulatory changes that impact highvolume procedures, such as TKA, in a short period of time and without appropriate feedback can only lead to further confusion. As surgeons, we are in a unique business model that requires us to constantly innovate to deliver high quality care, while also taking financial cuts as a result of our innovations.

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Day-case surgery for total hip and knee replacement

Cited by 44 publications

References 65 publications

Comparison of clinical and economic outcomes between the direct anterior approach and the posterolateral approach for primary total hip arthroplasty

Comparison of clinical and economic outcomes between the direct anterior approach and the posterolateral approach for primary total hip arthroplasty

Day-case total hip arthroplasty: a literature review and development of a hospital pathway

Total Knee Arthroplasty in Ambulatory Surgery Centers: The New Reality!

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