Discharge on the day of surgery following unicompartmental knee arthroplasty within the United Kingdom NHS

Bradley, B.; Middleton, Simon; Davis, Neil L.; Williams, M.; Stocker, Mary; Hockings, M.; Isaac, David

doi:10.1302/0301-620x.99b6.bjj-2016-0540.r2

Cited by 48 publications

(32 citation statements)

References 16 publications

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“…Jenkins et al (2019) reported reduced muscle strength to be the most common reason for continued hospitalization as well as dizziness and nausea. A study by Bradley et al (2017) reported a day of surgery discharge percentage of 85% (n=72). Patients in that study were included in the DOS discharge group only if they were cleared by a preoperative team after testing and optimizing their coexisting medical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…UKA is effective and safe when performed in a fast-track setting and outpatient UKA in selected patients has been shown to be feasible and safe (Munk et al 2012, Cross and Berger 2014, Bovonratwet et al 2017, Kort et al 2017. However, the number of patients actually being discharged on DOS that were scheduled for outpatient surgery differs between studies and ranges from 37% to 100% (Gondusky et al 2014, Bradley et al 2017, Jenkins et al 2019, Rytter et al 2019.…”

mentioning

confidence: 99%

“…In order to reduce LOS and increase patient satisfaction, a focus on successfully managing well-defined discharge criteria in a multimodal approach is imperative (Husted et al 2008, Cross andBerger 2014). In addition, decreased LOS and outpatient procedures are associated with financial benefits, which have further fueled interest in decreasing LOS and ensuring DOS discharged following UKA (Bradley et al 2017). Finally, decreased LOS is also shown to increase patient satisfaction levels (Reilly et al 2005, Richter andDiduch 2017).…”

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confidence: 99%

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Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

et al. 2020

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Background and purpose — Previous studies have investigated risk factors related to prolonged length of stay following total knee arthroplasty (TKA), but little is known about specific factors resulting in continued hospitalization within the 1st postoperative days after unicompartmental knee arthroplasty (UKA). We investigated what specific factors prevent patients from being discharged on the day of surgery (DOS) and the first postoperative day (POD-1) following primary UKA in a fast-track setting. Patients and methods — We prospectively collected data on 100 consecutive and unselected medial UKA patients operated from December 2017 to May 2019. All patients were operated in a standardized fast-track setup with functional discharge criteria continuously evaluated from DOS and until discharge. Results — Median length of stay for the entire cohort was 1 day. 22% and 78% of all patients were discharged on DOS and POD-1, respectively. Lack of mobilization and pain separately delayed discharge in respectively 78% and 24% of patients on DOS. The main reasons for lack of mobilization were motor blockade (37%) and logistical factors (26%). For patients placed 1st or 2nd on the operating list, we estimate that the same-day discharge rate would increase to 55% and 40% respectively, assuming that pain and mobilization were successfully managed. Interpretation — One-fifth of unselected UKA patients operated in a standardized fast-track setup were discharged on DOS. Pain and lack of mobilization were the major reasons for continued hospitalization within the initial postoperative 24–48 hours. Strategies aimed at decreasing length of stay after UKA should strive to improve analgesia and postoperative mobilization.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

et al. 2020

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“…Reducing the number of days patients spend in hospital is a priority in the NHS with a need to perform more short stay procedures. Bradley et al [3] reported their experience of day-case UKR with 130 consecutive patients over 46 months however only 72 patients met the inclusion criteria. The USA, Denmark and The Netherlands have also reported successful day-case UKR surgery [4][5][6][7] on highly selected cohorts of patients.…”

Section: Introductionmentioning

confidence: 99%

Introduction of an innovative day surgery pathway for unicompartmental knee replacement: no need for early knee flexion

et al. 2019

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Objectives To evaluate the introduction of an innovative rehabilitation protocol, delaying knee flexion, for patients receiving unicompartmental knee replacement. Design Longitudinal cohort. Setting Specialist Orthopaedic Unit within an NHS Foundation Trust. Participants 669 consecutive patients undergoing unicompartmental knee replacement. Intervention An innovative rehabilitation protocol, delaying knee flexion. Main Outcome Measures Length of stay, range of movement, Surgical Satisfaction Questionnaire. Results There were 669 consecutive primary unilateral unicompartmental knee replacements from September 2016 to February 2018. In total 264 patients (39%) went home on the day of surgery, 253 (38%) on day 1 and 152 (23%) stayed in 2 or more days (range 2 to 28 days). The mean length of stay reduced from 2.6 to 1.2 days (median 1 day). Mean flexion was 110 • (range 30 to 140) at 6 weeks. The surgical satisfaction questionnaire showed that 90% of patients discharged on day 0 were very satisfied with the results of surgery. Conclusion Many components of traditional care were altered to introduce this protocol. The most important factors were delayed knee flexion providing benefits in terms of early mobilisation with no short term detriment, physiotherapists working late shifts, a consistent message and patient education. It was safe, effective and patient satisfaction was high.

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“…Bradley et al have reported that patients can be safely and efficaciously discharged on the day of surgery after UKA, with high satisfaction. 35 This plainly offers improved management of assets and financial savings to the healthcare system. The most common causes of failure were logistical (the operation was too late in the day), inappropriate control of pain, and leaking wounds.…”

Section: Inpatient Versus Outpatient Ukamentioning

confidence: 99%

Unicompartmental knee arthroplasty

Rodríguez-Merchán¹,

Gómez-Cardero²

2018

EFORT Open Reviews

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An age younger than 60 years, a body weight of 180 lb (82 kg) or more, performing heavy work, having chondrocalcinosis and having exposed bone in the patellofemoral (PF) joint are not contraindications for unicompartmental knee arthroplasty (UKA).Severe wear of the lateral facet of the PF joint with bone loss and grooving is a contraindication for UKA.Medial UKA should only be performed in cases of severe osteoarthritis (OA) as shown in pre-operative X-rays, with medial bone-on-bone contact and a medial/lateral ratio of < 20%.The post-operative results of UKA are generally good. Medium-term and long-term studies have reported acceptable results at 10 years, with implant survival greater than 95% for UKAs performed for medial OA or osteonecrosis and for lateral UKA, especially when fixed-bearing implants are used.When all implant-related re-operations are considered, the 10-year survival rate is 94%, and the 15-year survival rate is 91%.Aseptic loosening is the principal failure mechanism in the first few years in mobile-bearing implants, whereas OA progression causes most failures in later years in fixed-bearing implants.The overall complication rate and the comprehensive re-operation rate are comparable in both mobile bearings and fixed bearings.The survival likelihood of the all-polyethylene UKA implant is similar to that of metal-backed modular designs for UKA.Notable cost savings of approximately 50% can be achieved with an outpatient UKA surgery protocol. Outpatient surgery for UKA is efficacious and safe, with satisfactory clinical results thus far.Cite this article: EFORT Open Rev 2018;3:363-373. DOI: 10.1302/2058-5241.3.170048

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Discharge on the day of surgery following unicompartmental knee arthroplasty within the United Kingdom NHS

Abstract: We found that patients can be safely and effectively discharged on the day of surgery after UKA, with high levels of satisfaction. This clearly offers improved management of resources and financial savings to healthcare trusts. Cite this article: 2017;99-B:788-92.

Cited by 48 publications

References 16 publications

Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

Introduction of an innovative day surgery pathway for unicompartmental knee replacement: no need for early knee flexion

Unicompartmental knee arthroplasty

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