Patient selection criteria for outpatient joint arthroplasty

Kort, Nanne P.; Bemelmans, Yoeri F. L.; Kuy, Hugo van der; Jansen, Jacqueline; Schotanus, Martijn G.M.

doi:10.1007/s00167-016-4140-z

Cited by 81 publications

(42 citation statements)

References 32 publications

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“…Specific patient factors and comorbidities have been identified that should require IP admission for TKA due to an increased risk of perioperative complications, including age > 75 years, uncontrolled diabetes, chronic obstructive pulmonary disease, high body mass index (BMI) (>35 kg/m 2 ), chronic opioid use, functional neurological impairments, dependent functional status, low preoperative cognitive capacity, congestive heart failure, liver cirrhosis, and chronic kidney disease. 14,28,29 Ideally, the optimal OP primary TKA candidate should have a BMI < 35 kg/m 2 , American Society of Anesthesiologists classification <3, strong social support system with an available "coach" for the first 2 postoperative weeks, be able and willing to participate in an OP program, and be < 75 years of age. 28,30 Further cohort investigations are critical to define the best candidates for safe, successful OP TKA.…”

Section: Risks Of Outpatient Tkamentioning

confidence: 99%

“…14,28,29 Ideally, the optimal OP primary TKA candidate should have a BMI < 35 kg/m 2 , American Society of Anesthesiologists classification <3, strong social support system with an available "coach" for the first 2 postoperative weeks, be able and willing to participate in an OP program, and be < 75 years of age. 28,30 Further cohort investigations are critical to define the best candidates for safe, successful OP TKA.…”

Section: Risks Of Outpatient Tkamentioning

confidence: 99%

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Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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The rise of improved perioperative recovery protocols after total knee arthroplasty (TKA) has led to faster, more streamlined hospital stays for many patients. Combined with the implementation of value-based care and bundled payment initiatives, there has been a paradigm shift toward outpatient TKA surgery. This change to practice has been accelerated by recent policy changes enacted by the Center for Medicaid and Medicare Services regarding the removal of TKA as an inpatient only procedure as well as some insurance companies denying preauthorization for inpatient stays after TKA. Our review aims to address the inclusion and exclusion criteria for outpatient TKA consideration, examine the outcomes for outpatient joint replacement surgery, and discuss limitations of widespread adoption for same-day discharges.

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Section: Risks Of Outpatient Tkamentioning

confidence: 99%

Section: Risks Of Outpatient Tkamentioning

confidence: 99%

Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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“…It is important to select appropriate candidates and optimize Primary Total Knee Arthroplastyevery facet of their condition [7]. There are several key factors that should be considered to minimize the risks of complications and comorbidities [8].…”

Section: Preoperative Managementmentioning

confidence: 99%

Fast Track Surgery Program in Knee Replacement

Wang¹,

Chang²,

Chen³

et al. 2018

Primary Total Knee Arthroplasty

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A Fast-track (FT) program, a well-established approach for patients undergoing selective operations, aims at enhanced post-operative recovery. It was first introduced by Professor Henrik Kehlet in 1990s and was applied in colorectal surgery. With the increasing elderly population as well as the increasing incidence of osteoarthritis, the rapid growth of requirement of joint arthroplasties is to be expected. Therefore, many orthopedic teams have applied related principles to their daily practice of total knee arthroplasty to accelerate rehabilitation with lower mortality and morbidity, and to optimize patient satisfaction. The program is a multimodal and multidisciplinary standardized care. Various caring specialties are involved to fulfill the goals of the fast-track program; the basic members include anesthetists, surgeons, pain specialist, physiotherapists, nurses and even medical physicians. In general, the strategy consists of five strands: careful patient selection, improving preoperative care, minimizing perioperative stresses, decreasing postoperative discomfort, and improving postoperative recovery. Through full understanding of these strands and concepts, a comprehensive, perioperative care is thus constructed. This review article gives reader an overall concept of fast track surgery in total knee replacement surgery. A comprehensive search in English literature, including case series, associate randomized controlled trials and systematic reviews were performed using the PubMed databases in 2017 December.

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“…Such optimization is also known as 'outpatient joint arthroplasty' , a multimodal clinical pathway based on well-defined patient selection criteria [1][2][3] with the focus on discharge on the day of surgery while ensuring patients' safety [1,[4][5][6][7][8] and cost reduction [9,10,11]. Results have shown that quality of life after TKA, significantly improved within one year postoperative [11].…”

Section: Introductionmentioning

confidence: 99%

Improved Health-Related Quality of Life after Knee Arthroplasty Following an Outpatient Surgery Pathway: an Observational Comparative Case Study

Schotanus¹,

Bemelmans²,

Kort³

2017

J Clin Trial

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Purpose: Enhanced recovery pathways after knee arthroplasty have been introduced worldwide with positive results. The present study investigated the improvements of health-related quality of life and functional outcome in patients operated for knee arthroplasty who followed an Outpatient Surgery (OS) or Enhanced Recovery (ER) pathway. Methods:We reviewed our institutional database of 361 consecutive patients undergoing knee arthroplasty (total and partial) who followed either the OS-pathway (n=94; 26.1%) or ER-pathway (n=267; 73.9%). Recorded outcomes included 4 different patient reported outcome measures (PROMs; EuroQol-5D (both index and VAS), Oxford Knee Score, Western Ontario and McMaster Universities Arthritis Index and the Pain-Numerical Rating Scale) obtained pre-and during the 3-and 12-months postoperative follow-up.Results: 93 patients (99%) in the OS-group were discharged on the day of surgery as scheduled, whereas in the ER-group 70% of the patients were discharged<3 days postoperatively. At 12-month follow-up, the EQ-5D (both index and VAS) and other PROMs improved significantly (p<0.000) within each pathway. There were no significant differences between both pathways. Conclusion:One year after knee arthroplasty, patients who were included in an Outpatient Surgery pathway had comparable quality of life and PROMs as patients operated in an Enhanced Recovery pathway. Level of evidence:Case control study, Level III.

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Patient selection criteria for outpatient joint arthroplasty

Abstract: Clinical review, Level III.

Cited by 81 publications

References 32 publications

Inpatient versus Outpatient Total Knee Arthroplasty

Inpatient versus Outpatient Total Knee Arthroplasty

Fast Track Surgery Program in Knee Replacement

Improved Health-Related Quality of Life after Knee Arthroplasty Following an Outpatient Surgery Pathway: an Observational Comparative Case Study

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