Study protocol for discharge on day of surgery after hip and knee arthroplasty from the Center for Fast-track Hip and Knee Replacement

Abstract

Background and purpose: Limited data exists on the implementation process and safety of discharge on the day of surgery after primary hip and knee arthroplasty in a multicenter setting. We report our study protocol on the investigation of the feasibility, safety, and socioeconomic aspects following discharge on day of surgery after hip and knee arthroplasty across 8 fast-track centers.Patients and methods: This is a study protocol for a prospective cohort study on discharge on day of surgery from the Center for Fast-track Hip and Knee Replacement. The collaboration includes 8 centers covering 40% of the primary hip and knee arthroplasty procedures undertaken in Denmark. All patients scheduled for surgery are screened for eligibility using well-defined inclusion and exclusion criteria. Eligible patients fulfilling discharge criteria will be discharged on day of surgery. We expect to screen 9,000 patients annually.Duration and outcome: Patients will be enrolled over a 3-year period from September 2022 and reporting of results will run continuously until December 2025. We shall report the proportion of eligible patients and patients discharged on day of surgery as well as limiting factors. Readmissions and complications within 30 days are recorded with real-time follow-up by research staff. Furthermore, patient-reported information on willingness to repeat discharge on day of surgery, contacts with the healthcare system, complications, and workability is registered 30 days postoperatively. EQ-5D, Oxford Knee Score, and Oxford Hip Score are completed preoperatively and after 3 months and 1 year. Finally, outcome data will be used in the development of a prediction model for successful discharge on the day of surgery.

Protocol for a prospective multicentre cohort study to address the question whether diabetes and its management is still a risk factor in fast-track joint arthroplasty

“…Postoperative thromboprophylaxis is given 6–8 hours after surgery and used only during hospitalisation when LOS is 5 days or less. Key points for the fast-track protocol are listed in box 1 9 13…”

“…The data collection includes patient-reported data from questionnaires, online or on paper, with help from the research staff, along with data extraction from electronic medical records with backup from physicians if needed 13. All data are collected by research staff in a systematic way both preoperatively and postoperatively.…”

Implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting

“…Only 3 of the 8 centers had previous experience with use of outpatient surgery before the study period. An educational program was introduced supporting that all centers followed the same protocol [ 13 ]. The study period was from September 1, 2022, to February 28, 2023, with centers labelled A–G.…”

“…Although selective use of outpatient surgery in individual centers has been shown to be feasible, the use of outpatient surgery on a national level is low [ 11 , 12 ]. Therefore, the study group designed a detailed protocol for the implementation of outpatient surgery in a multicenter collaboration across all regions in Denmark [ 13 ].…”

Fast Track Protocols and Early Rehabilitation after Surgery in Total Hip Arthroplasty: A Narrative Review

“…Fast Track treatment also focuses on providing improved nutritional support, enforcing physical activity, and offering updated postoperative nursing care and rehabilitation [ 32 , 33 , 34 ]. The overall ERAS program works if patients have been thoroughly informed, and if they are encouraged to actively participate in their care and rehabilitation [ 29 , 35 , 36 ].…”