Day-case success or why still in hospital after total hip, total knee, and medial unicompartmental knee arthroplasties?

Autor:	Danielsen O; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Svendborg, Denmark., Jensen CB; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark., Varnum C; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery, Lillebaelt Hospital - Vejle, Vejle, Denmark., Jakobsen T; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark., Andersen MR; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark., Bieder MJ; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark., Overgaard S; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Jørgensen CC; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Anaesthesia, Hospital of Northern Zeeland, Hillerød, Denmark., Kehlet H; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Gromov K; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark., Lindberg-Larsen M; Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Svendborg, Denmark.
Jazyk:	angličtina
Zdroj:	Bone & joint open [Bone Jt Open] 2024 Nov 05; Vol. 5 (11), pp. 977-983. Date of Electronic Publication: 2024 Nov 05.
DOI:	10.1302/2633-1462.511.BJO-2024-0125.R1
Abstrakt:	Aims: Day-case success rates after primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and medial unicompartmental knee arthroplasty (mUKA) may vary, and detailed data are needed on causes of not being discharged. The aim of this study was to analyze the association between surgical procedure type and successful day-case surgery, and to analyze causes of not being discharged on the day of surgery when eligible and scheduled for day-case THA, TKA, and mUKA. Methods: A multicentre, prospective consecutive cohort study was carried out from September 2022 to August 2023. Patients were screened for day-case eligibility using well defined inclusion and exclusion criteria, and discharged when fulfilling predetermined discharge criteria. Day-case eligible patients were scheduled for surgery with intended start of surgery before 1.00 pm. Results: Of 6,142 primary hip and knee arthroplasties, eligibility rates for day-case surgery were 34% for THA (95% CI 32% to 36%), 34% for TKA (95% CI 32% to 36%), and 52% for mUKA (95% CI 49% to 55%). Surgery before 1.00 pm was achieved in 85% of eligible patients. The day-case success rate among patients with surgery before 1.00 pm was 59% (95% CI 55% to 62%) for THA, 61% (95% CI 57% to 65%) for TKA, and 72% (95% CI 68% to 76%) for mUKA. Overall day-case success rates (eligible and non-eligible) were 19% (95% CI 17% to 20%) for THA, 20% (95% CI 18% to 21%) for TKA, and 42% (95% CI 39% to 45%) for mUKA. Adjusted analysis confirmed higher day-case success in eligible mUKA patients (odds ratio 1.9 (1.6 to 2.3)) compared to TKA and THA patients. Primary causes for day-case failure were mobilization issues (9% to 12% between procedures), prolonged spinal anaesthesia (4% to 9%), and postoperative nausea and vomiting (PONV) (4% to 14%). Conclusion: THA and TKA patients showed comparable eligibility (34%) with similar day-case success rates (59 to 61%), whereas mUKA patients demonstrated higher eligibility (52%) and day-case success (72%). Mobilization issues, prolonged spinal anaesthesia, and PONV were the most frequent causes for not being discharged. Competing Interests: The salary for PhD student O. Danielsen was provided through funding from the Candy's Foundation, the University of Southern Denmark, and the Region of Southern Denmark. C. Varnum received travel expenses from Stryker, which is unrelated to this work. M. R. Andersen is secretary of the Danish Society for Hip and Knee Arthroplasty, which is unrelated. S. Overgaard received personal payment for a lecture from Johnson & Johnson, and institutional payment for being a course moderator and lectures from Heraeus, which are unrelated. C. C. Jørgensen received personal speaker fees and travel support from Pharmacosmos, unrelated to this work. H. Kehlet is on the Zimmer Biomet advisory board on rapid recovery. K. Gromov received research and institutional support from Zimmer Biomet, which was also unrelated. (© 2024 Danielsen et al.)
Databáze:	MEDLINE
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