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

Abstract

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.

Converting hip and knee arthroplasty cases to same-day surgery due to COVID-19

“… 20 Surrogates for elective surgery, such as the use of THA for hip fractures, also showcased the ability to provide arthroplasty services safely amid the COVID-19 pandemic. 21 A review and protocol by Haddad et al 22 identified several variables that were addressed to ensure that day surgery was feasible in the time of pandemic. These guidelines were also mirrored by the International Consensus Group of American Association of Hip and Knee Surgery (AAHKS).…”

The Efficacy of Bone Wax in Reduction of Perioperative Blood Loss in Total Hip Arthroplasty via Direct Anterior Approach

“…A host of preoperative, intraoperative, and postoperative strategies have been developed to minimize PBL 36 . Some centers have even used these strategies to define standard operating pathways for outpatient THA 4 . Recent studies have shown that the integrated use of these measures has resulted in a considerable decrease in PBL and transfusion rates following THA [37][38][39] .…”

“…As a prototype in PBM, TXA has reduced PBL by ;400 mL 38 . Despite these advances, no efforts should be spared to reduce PBL, which is of particular concern in patients undergoing outpatient THA, elderly patients, and patients with preoperative anemia 4,[40][41][42] .…”

“…Overall, these complications can lead to higher morbidity, longer hospital stays, and increased costs 13 . Although the extremely high rates of PBL and transfusion that were reported in older studies have not been reported in recent literature, minimizing PBL is still essential not only in the traditional inpatient setting but also in the setting of outpatient THA 4,17 .…”

“…As a result of the aging of the population and the obesity epidemic, it has been estimated that the frequency of THA will increase by 400% from the 2000s to 2030 2,3 . The existing health-care economic crisis has highlighted the need for a more cost-containing perspective on THA, focusing more on optimizing perioperative measures such as patient education, perioperative blood loss (PBL) management, and rehabilitation 4-6 . Notably, outpatient THA was introduced in an attempt to address all of these issues concomitantly 7 .…”