Introduction of day case hip and knee replacement programme at an inpatient ward is safe and may expedite shortening of hospital stays of traditional arthroplasties

Abstract

Purpose We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward. Methods 200 patients underwent elective, unilateral primary day case total hip (THA, n = 94), total knee (TKA, n = 60) and unicondylar knee replacements (UKA, n = 46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n = 6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period. Results 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5%), urine retention (3%) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. Conclusion Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.

Successful same-day discharge in 88% of patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis

“…( 9) An adequate control group: having a gold standard diagnostic test or therapeutic intervention recognized as the optimal intervention according to the available published data. (10) [31] 2020 Knee IV 2 2 1 2 0 2 2 ----11 Barrie et al [1] 2021 Knee IV 2 2 2 2 0 2 2 0 ----12 Keulen et al [22] 2021 J Arthroplasty III 2 2 1 2 0 2 2 2 2 2 2 19 Lan et al [25] 2021 J Bone Joint Surg III 2 2 1 2 0 2 2 2 2 2 2 19 Lovasz et al [27] 2021 J Orthop Surg Rel IV 2 1 1 2 0 2 2 ----10 Mouli et al [30] 2021 Sensors IV 2 1 2 2 0 2 2 ----11 Patel et al [35] 2021 Knee IV 2 2 1 2 1 2 2 ----14 Saunders et al [40] 2021 BJO III 2 1 2 2 0 2 2 2 2 1 2 18 Tveit [42] 2021 Plos One IV 2 2 2 2 0 2 2 ----14 Yang et al [46] 2021 Bone Jt J III 2 1 1 2 0 2 2 2 1 2 2 17 Gao et al [14] 2022 Musculoskeletal Care III 2 2 2 2 0 2 2 2 2 2 2 21…”

“…Optimization of perioperative protocols and surgical techniques have largely overcome traditional reasons for hospital admission after joint arthroplasty (e.g., pain, decreased mobility), paving the way for same-day home discharge after such procedures [ 4 ]. Several day-case UKA pathways have demonstrated excellent results in terms of success rates and adverse events [ 1 , 4 , 12 , 18 , 27 , 38 ]. However, most of these studies were performed with carefully selected patients, and the current literature remains divided on the feasibility of day-case UKA without preselection of patients [ 3 , 8 ].…”

Applying models of care for total hip and knee arthroplasty: External validation of a published predictive model to identify extended stay risk prior to lower-limb arthroplasty

“…26,28 It is well documented that not all patients are suitable for this pathway and having tools that are still capable of identifying patients likely to stay beyond the current target of three days have clinical applicability. 27 The clinical utility (0.03 at threshold probability of 0.5) for the selected model was lower compared to other published models (e.g. machine learning), 29 with net benefit of approximately 0.17-0.25 at the same probability threshold.…”

“…Clinical and administrative culture, attitudes and policies towards shorter stay have evolved over this time with the most recent shift being towards same day discharge. 26,27 Although there is a trend towards day of surgery discharge, this still represents a very small percentage of the lower limb total arthroplasty population with incidence ranging from 0.5% to 2.9%. 26,28 It is well documented that not all patients are suitable for this pathway and having tools that are still capable of identifying patients likely to stay beyond the current target of three days have clinical applicability.…”

“…26,28 It is well documented that not all patients are suitable for this pathway and having tools that are still capable of identifying patients likely to stay beyond the current target of three days have clinical applicability. 27…”