Introducing a day-case arthroplasty pathway significantly reduces overall length of stay

Aims: Day-case arthroplasty is gaining popularity in Europe. We report outcomes from the first 12 months following implementation of a day-case pathway for unicompartmental knee arthroplasty (UKA) and total hip arthroplasty (THA) in an NHS hospital. Methods: A total of 47 total hip arthroplasty (THA...

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Autores principales:	Paul Saunders, Nick Smith, Farhan Syed, Thomas Selvaraj, Jon Waite, Stephen Young
Formato:	article
Lenguaje:	EN
Publicado:	The British Editorial Society of Bone & Joint Surgery 2021
Materias:	day-case arthroplasty same-day discharge length of stay nhs unicompartmental knee arthroplasty (uka) total hip arthroplasty (tha) anaesthetics total knee arthroplasty (tka) fentanyl hypotension lower limb arthroplasty patient-reported outcomes hip and knee arthroplasty Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/f995af515734482984d44910b3852cd8
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spelling	oai:doaj.org-article:f995af515734482984d44910b3852cd82021-12-01T18:44:47ZIntroducing a day-case arthroplasty pathway significantly reduces overall length of stay2633-146210.1302/2633-1462.211.BJO-2021-0106.R1https://doaj.org/article/f995af515734482984d44910b3852cd82021-11-01T00:00:00Zhttps://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.211.BJO-2021-0106.R1https://doaj.org/toc/2633-1462Aims: Day-case arthroplasty is gaining popularity in Europe. We report outcomes from the first 12 months following implementation of a day-case pathway for unicompartmental knee arthroplasty (UKA) and total hip arthroplasty (THA) in an NHS hospital. Methods: A total of 47 total hip arthroplasty (THA) and 24 unicompartmental knee arthroplasty (UKA) patients were selected for the day-case arthroplasty pathway, based on preoperative fitness and agreement to participate. Data were likewise collected for a matched control group (n = 58) who followed the standard pathway three months prior to the implementation of the day-case pathway. We report same-day discharge (SDD) success, reasons for delayed discharge, and patient-reported outcomes. Overall length of stay (LOS) for all lower limb arthroplasty was recorded to determine the wider impact of implementing a day-case pathway. Results: Patients on the day-case pathway achieved SDD in 47% (22/47) of THAs and 67% (16/24) of UKAs. The most common reasons for failed SDD were nausea, hypotension, and pain, which were strongly associated with the use of fentanyl in the spinal anaesthetic. Complications and patient-reported outcomes were not significantly different between groups. Following the introduction of the day-case pathway, the mean LOS reduced significantly by 0.7, 0.6, and 0.5 days respectively in THA, UKA, and total knee arthroplasty cases (p < 0.001). Conclusion: Day-case pathways are feasible in an NHS set-up with only small changes required. We do not recommend fentanyl in the spinal anaesthetic for day-case patients. An important benefit seen in our unit is the so-called ‘day-case effect’, with a significant reduction in mean LOS seen across all lower limb arthroplasty. Cite this article: Bone Jt Open 2021;2(11):900–908.Paul SaundersNick SmithFarhan SyedThomas SelvarajJon WaiteStephen YoungThe British Editorial Society of Bone & Joint Surgeryarticleday-casearthroplastysame-day dischargelength of staynhsarthroplastyunicompartmental knee arthroplasty (uka)total hip arthroplasty (tha)anaestheticstotal knee arthroplasty (tka)fentanylhypotensionlower limb arthroplastypatient-reported outcomeship and knee arthroplastyOrthopedic surgeryRD701-811ENBone & Joint Open, Vol 2, Iss 11, Pp 900-908 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	day-case arthroplasty same-day discharge length of stay nhs arthroplasty unicompartmental knee arthroplasty (uka) total hip arthroplasty (tha) anaesthetics total knee arthroplasty (tka) fentanyl hypotension lower limb arthroplasty patient-reported outcomes hip and knee arthroplasty Orthopedic surgery RD701-811
spellingShingle	day-case arthroplasty same-day discharge length of stay nhs arthroplasty unicompartmental knee arthroplasty (uka) total hip arthroplasty (tha) anaesthetics total knee arthroplasty (tka) fentanyl hypotension lower limb arthroplasty patient-reported outcomes hip and knee arthroplasty Orthopedic surgery RD701-811 Paul Saunders Nick Smith Farhan Syed Thomas Selvaraj Jon Waite Stephen Young Introducing a day-case arthroplasty pathway significantly reduces overall length of stay
description	Aims: Day-case arthroplasty is gaining popularity in Europe. We report outcomes from the first 12 months following implementation of a day-case pathway for unicompartmental knee arthroplasty (UKA) and total hip arthroplasty (THA) in an NHS hospital. Methods: A total of 47 total hip arthroplasty (THA) and 24 unicompartmental knee arthroplasty (UKA) patients were selected for the day-case arthroplasty pathway, based on preoperative fitness and agreement to participate. Data were likewise collected for a matched control group (n = 58) who followed the standard pathway three months prior to the implementation of the day-case pathway. We report same-day discharge (SDD) success, reasons for delayed discharge, and patient-reported outcomes. Overall length of stay (LOS) for all lower limb arthroplasty was recorded to determine the wider impact of implementing a day-case pathway. Results: Patients on the day-case pathway achieved SDD in 47% (22/47) of THAs and 67% (16/24) of UKAs. The most common reasons for failed SDD were nausea, hypotension, and pain, which were strongly associated with the use of fentanyl in the spinal anaesthetic. Complications and patient-reported outcomes were not significantly different between groups. Following the introduction of the day-case pathway, the mean LOS reduced significantly by 0.7, 0.6, and 0.5 days respectively in THA, UKA, and total knee arthroplasty cases (p < 0.001). Conclusion: Day-case pathways are feasible in an NHS set-up with only small changes required. We do not recommend fentanyl in the spinal anaesthetic for day-case patients. An important benefit seen in our unit is the so-called ‘day-case effect’, with a significant reduction in mean LOS seen across all lower limb arthroplasty. Cite this article: Bone Jt Open 2021;2(11):900–908.
format	article
author	Paul Saunders Nick Smith Farhan Syed Thomas Selvaraj Jon Waite Stephen Young
author_facet	Paul Saunders Nick Smith Farhan Syed Thomas Selvaraj Jon Waite Stephen Young
author_sort	Paul Saunders
title	Introducing a day-case arthroplasty pathway significantly reduces overall length of stay
title_short	Introducing a day-case arthroplasty pathway significantly reduces overall length of stay
title_full	Introducing a day-case arthroplasty pathway significantly reduces overall length of stay
title_fullStr	Introducing a day-case arthroplasty pathway significantly reduces overall length of stay
title_full_unstemmed	Introducing a day-case arthroplasty pathway significantly reduces overall length of stay
title_sort	introducing a day-case arthroplasty pathway significantly reduces overall length of stay
publisher	The British Editorial Society of Bone & Joint Surgery
publishDate	2021
url	https://doaj.org/article/f995af515734482984d44910b3852cd8
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Introducing a day-case arthroplasty pathway significantly reduces overall length of stay

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