Outcome Analysis of Outpatient Total Knee and Total Hip Arthroplasty: A Follow up upto three Months
Abstract
Traditionally total knee and hip arthroplasty surgeries requires long duartion of hospital stay. More duration of stay has its own disadvantages. So it was tried to developed an accelerated clinical pathway for patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) who are considered healthy enough for early discharge. Between March 2013 – April2014, 89 TKA and 116 THA were performed to different patients at a single institution by a single orthopedic surgeon. 71 (31 TKA, 40 THA) met the inclusion criteria for the study. All patients received 2 grams of tranexamic acid and 750 mg cefuroxime sodium intravenously at 30 minutes prior to surgery. A multi-modal protocol for perioperative pain management was used for all patients. Out of total 71 patients (12 males, 59 females) with a mean age of 59 years (range, 24-79 years). The mean length of hospital stay was 27,3 hours (range, 15-60 hours). The mean duration of surgery was 92 minutes (range, 75-128 minutes) for TKA, 72 minutes (range, 48-81 minutes) for THA. Combined spinal epidural anesthesia was performed in 55 patients (77%) and general anesthesia in 16 patients (23%). Of the total 71 patients, 51 (71,8%) were discharged within 23 hours after surgery. Only 11(15.5%) were re-addmitted because of minor complains. These results of this study demonstrated that early discharge does not result in significant complications related to the outpatient procedure in selected patients up to three months postoperatively.
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Introduction
Traditionally total knee and hip arthroplasty surgeries have been performed in an in-patient setting. The average length of stay after total knee arthroplasty (TKA) and total hip arthroplasty (THA) has decreased in recent years because of improved postoperative clinical pathways. 1-3 These are improvements in postoperative pain management, rehabilitation protocols, less invasive surgical techniques, and early mobilization of the patients. Previous publications have revealed that the average length of stay can be decreased without increasing perioperative complications. 4-5 We have developed an accelerated clinical pathway for patients undergoing TKA and THA who are considered healthy enough for early discharge. This pathway combines preoperative patient education, oral pain medications, early mobilization and intensive physical therapy. The purpose of this study is to report our initial experience of attempting outpatient TKA and THA.
Conclusion
This study was designed to describe our initial experience regarding outpatient TKA and THA using an accelerated clinical pathway. As the ageing population increases, so the demand for joint arthroplasty will increase. Healthcare systems force the orthopedic surgeons to produce successful outcomes and reduce the cost to the system. Although no financial analysis was made in this study just outcome analysis of traditional TKA and THA patients, as in this study 71.8% patients were discharged within 24 hours and all patients were discharged within 48 hours. Only 15.5% of these cases were re-admmited because of minor complains. So this study demonstrated that early discharge does not result in significant complications related to the outpatient procedure in selected patients.