Preoperative Oral Hydration Is Safe in Rapid Recovery Total Hip Arthroplasty

Abstract

Fluid and food restrictions prior to surgery are thought to reduce the risk for perioperative aspiration pneumonia. However, the recent anesthesia literature suggests that clear fluids up to 2 hours before surgery may be tolerated. Here we investigate the safety and efficacy of a standardized hydration protocol among same-day discharge total hip arthroplasty (SDD-THA) candidates. All patients scheduled to undergo primary SDD THA between January 2017 and October 2018 were included. Surgical recipients between January 2017 and August 2017 were used as historical controls. Surgical recipients between September 2017 and October 2018 participated in the hydration initiative which allowed for the consumption of 32 oz of clear fluid 2 hours prior to surgery. Baseline demographics and quality metrics were prospectively collected and analyzed to define the impact of a hydration protocol in SDD THA. In total, 585 consecutive SDD-THA candidates were included in this study, of which 309 and 276 patients were in the control and hydration cohorts, respectively. Univariable analysis of postoperative outcomes demonstrated that a similar number of THA recipients failed SDD (7.44 vs. 7.97%; p = 0.88); however, a clinically meaningful reduction in hypotensive episodes was observed among the hydration cohort (0.4 vs. 1.9%; p = 0.08). Multivariable regression demonstrated similar outcomes after controlling for all collected patient risk factors (odds ratio 0.95; 95% confidence interval 0.48–1.88; p = 0.89). Our study suggests hydration protocols are safe and may reduce the clinical incidence of postoperative hypotension when compared with standard nil per os restrictions. Future studies are needed to better elucidate the role of perioperative hydration before THA. The level of evidence of the study is level II, prospective observational cohort.