High-volume day-case hip arthroplasty in a district general hospital

With the increasing burden of arthroplasty waiting lists within Northern Ireland, this study aims to evaluate the safety, efficacy, and postoperative outcomes following the introduction of a high-volume day-case arthroplasty unit in a district general hospital (South West Acute Hospital (SWAH)), with no previous routine orthopaedic service.

An independent company was contracted to provide high-volume, day-case arthroplasty. Standardization of care, enhanced recovery after surgery (ERAS) principles, and recruiting experienced staff were important steps in the set-up. This study includes the first 244 total hip arthroplasty (THA) cases performed. A matched cohort of 43 THA patients was compared with patients from the largest elective unit in Northern Ireland (Musgrave Park Hospital) to ensure satisfactory outcomes in the 90-day postoperative period.

Same-day discharge was achieved in 83.7% of cases performed in SWAH which compared with 4.7% of MPH patients (p < 0.001). There was no significant difference in rates of attendance to an out of hours general practioner (7% vs 9.3%, p = 0.693) or emergency department (11.6% vs 16.3%, p = 0.757). Readmission rates (2.3% vs 11.6%) and reoperation rates (2.3% vs 0%) also did not show any significant difference (p = 0.202 and p = 0.500, respectively). No patient in either matched cohort had a venous thromboembolism diagnosed. Between the matched cohorts, there was a significantly higher number of American Society of Anesthesiologists grade I and II patients performed at SWAH (p = 0.003); however, this was likely due to the strict exclusion criteria necessary for the safe implementation of a day-case arthroplasty unit.

An arthroplasty day-case service was safely set up in a district general hospital without a previous orthopaedic unit. More than 80% of these patients were discharged on the same day of surgery. With the ever-increasing pressure, demand, and waiting lists for arthroplasty, this model could prove an important adjunct to existing services.