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Outpatient total hip and knee arthroplasty
Stephan B W Vehmeijer1,2, Henrik Husted3,4, Henrik Kehlet5,4
1a Department of Orthopedic Surgery , Reinier de Graaf Groep , Delft , The Netherlands.
Acta Orthopaedica
|December 6, 2017
Summary
Fast-track programs enable same-day discharge after arthroplasty, but defining "outpatient" is crucial. Further research is needed to address challenges and confirm the financial benefits of outpatient arthroplasty.
Area of Science:
- Orthopedic Surgery
- Enhanced Recovery After Surgery (ERAS) Protocols
Background:
- Fast-track programs have significantly reduced hospital stays post-arthroplasty.
- Selected patients may be eligible for outpatient procedures, but definitions vary in literature.
Purpose of the Study:
- To propose a precise definition for "outpatient" arthroplasty, exclusively for same-day discharge without overnight stays.
- To identify challenges and prerequisites for establishing successful outpatient arthroplasty procedures.
Main Methods:
- Review of existing literature on fast-track programs and outpatient arthroplasty.
- Analysis of patient recovery factors, including preoperative steroids and multimodal analgesia.
- Consideration of logistical and financial aspects of same-day discharge.
Main Results:
- A clear definition of "outpatient" arthroplasty is proposed: discharge home on the day of surgery with no overnight stay.
- Preoperative high-dose steroids and opioid-sparing analgesia enhance recovery but require management of pathophysiological responses.
- Careful consideration is needed to avoid unnecessary costs associated with same-day discharge protocols.
Conclusions:
- Standardizing the definition of outpatient arthroplasty is essential for clear communication and research.
- Optimizing patient recovery and managing physiological responses are critical for successful outpatient arthroplasty.
- Further cost-benefit analyses are required to validate the financial advantages of outpatient arthroplasty.
