Day of surgery discharge success after implementation of a rapid discharge protocol following unilateral unicompartmental knee arthroplasty

Nakasone, Cass K.; Combs, Dylan B.; Buchner, Brian R.; Andrews, Samantha

doi:10.1016/j.knee.2020.03.003

Cited by 21 publications

(11 citation statements)

References 12 publications

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“…Few studies have evaluated the generalizability of same-day PKR surgery. With no preselection of patients, a span from 22% to 84% successful SDD achievements have been reported depending on the study [ 20 , 36 , 41 , 49 ]. In two studies, immobilization [ 20 , 41 ] was reported to be the main reason for not achieving SDD, whereas two other studies reported nausea [ 36 , 49 ] to be the main reason.…”

Section: Discussionmentioning

confidence: 99%

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

Tveit

2021

PLoS ONE

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Purpose Programs referred to as Fast-Track/Rapid Recovery/Enhanced Recovery After Surgery have proven both effective and safe in joint replacement surgery, to the degree where same-day discharge (SDD) has been attempted in carefully selected cases at specialized outpatient units. Therefore, the primary aim of this study was to evaluate a same-day surgery protocol regarding safety using the minor partial knee replacement (PKR) procedure by non-selectively recruiting patients at a public hospital for one consecutive year. Methods 33 unselected PKR cases were included in this open clinical trial. The inclusion/exclusion criteria were solely based on logistics, as all the procedures were medial PKRs, designated the first morning slots, and performed by one single-surgeon. Strict postoperative criteria based on vital parameters, urinary function, bleeding, and mobilization had to be met before discharge was considered. SDD rate, patient satisfaction, number of outpatient visits, adverse events and readmissions within 90 days were evaluated. A predetermined subgroup analysis was also conducted where patients <80 yrs. and with an American Society of Anesthesiologists (ASA) classification <III was compared with those aged ≥80 yrs. and/or ASA class ≥III. Results 29 of 33 (88%) successfully achieved SDD. In a univariate comparison, 100% of the patients <80 yrs. and ASA class <III achieved SDD, whereas a corresponding 43% applied for those aged ≥80 yrs. and/or ASA class ≥III (p = 0.001). A 93% overall satisfaction rate was reached. Only 8% extra outpatient visits were required, all occurring within the first 2 weeks (well in line with routine practice.) One plausible transient ischemic attack and one readmission caused by a penetrating trauma not affecting the knee were identified, both of which happened 10 weeks after surgery. No adverse events or readmissions occurred within the first 48 hours of surgery. Conclusion When following strict criteria for discharge, same-day partial knee replacement surgery may be both feasible and safe, even without preselection of patients.

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Section: Discussionmentioning

confidence: 99%

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

Tveit

2021

PLoS ONE

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“…Third, neither racial/ethnic nor SES differences were not seen in analyses of trends for individual medical and surgical diagnoses of policy importance. This may reflect the concerted attempts by hospitals (e.g., discharge protocols, 34,35 checklists, 35 care management 36 ) to manage quality outcomes, processes and health-related outcomes in these patient subgroups because of related financial penalties. Furthermore, observed racial/ethnic and SES differences in aALOS may reflect the case mix at the ward-level.…”

Section: Discussionmentioning

confidence: 99%

Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis

Ghosh

Unruh

Soroka

et al. 2021

Health Services Research and Managerial Epidemiology

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Background: Length of stay (LOS), a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES) and longer LOS is associated with adverse health outcomes. Historically, projects to improve LOS efficiency have yielded LOS reductions by 0.3 to 0.7 days per admission. Objective: To assess differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Method: Data were obtained from 2009-2014 Healthcare Cost and Utilization Project State Inpatient Datasets for New York, New Jersey, and Florida. Multivariate generalized linear models were used to examine trends in aALOS differences by race/ethnicity, and by high vs low SES patients (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. Results: For those discharged home, racial/ethnic and SES aALOS differences remained stable from 2009 to 2014. However, among those discharged to non-home destinations, Black vs White aALOS differences increased from 0.21 days in Q1 2009, (95% confidence interval (CI): 0.13 to 0.30) to 0.32 days in Q3 2013, (95% CI: 0.23 to 0.40), and for low vs high SES patients from 0.03 days in Q1 2009 (95% CI: -0.04 to 0.1) to 0.26 days, (95% CI: 0.19 to 0.34). Notably, for patients not discharged home, racial/ethnic and SES aALOS differences increased and persisted after Q3 2011, coinciding with the introduction of the Affordable Care Act (ACA). Conclusion: Further research to understand the ACA’s policy impact on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

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“…Third, neither racial/ethnic nor SES differences were not seen in analyses of trends for individual medical and surgical diagnoses of policy importance. This may reflect the concerted attempts by hospitals (e.g., discharge protocols, 36,37 checklists, 37 care management 38 ) to manage quality outcomes, processes and health-related outcomes in these patient subgroups because of related financial penalties. Furthermore, observed racial/ethnic and SES differences in aALOS may reflect the case mix at the ward-level.…”

Section: Discussionmentioning

confidence: 99%

Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

Ghosh

Unruh

Soroka

et al. 2021

Preprint

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Length of stay, a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES). Longer LOS is associated with adverse health outcomes. We assessed differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Using the 2009-2014 State Inpatient Datasets from three states, we examined trends in aALOS differences by race/ethnicity, and SES (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. For those discharged home, racial/ethnic and SES aALOS differences remained stable. Notably, for those discharged to non-home destinations, Black vs White, and low vs high SES aALOS differences increased significantly from 2009 to 2013, more sharply after Q3 2011, the introduction of the Affordable Care Act (ACA). Further research to understand the impact of the ACA on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

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Day of surgery discharge success after implementation of a rapid discharge protocol following unilateral unicompartmental knee arthroplasty

Cited by 21 publications

References 12 publications

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

On the generalizability of same-day partial knee replacement surgery—A non-selective interventional study evaluating efficacy, patient satisfaction, and safety in a public hospital setting

Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis

Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

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