Introduction
Fast track recovery pathways have reduced hospital length of stay (LOS) allowing patients to be discharged quicker. LOS for elective hip and knee replacements has drastically decreased in the last 2 decades .Day case arthroplasty was introduced at our hospital in 2018 when the average LOS was 2.4 days and about 15% of patients were discharged after 1 night stay. The purpose of this presentation is to share our experience with day case hip and knee arthroplasty after our first 1000 patients treated as day case.
Methods
ASA 1-2, motivated and with good preoperative mobility and family support.
Patients (ASA 1-2) were booked for hip or knee arthroplasty. Same day discharge(SDD), readmission, complication and satisfaction rates were recorded in addition to the standard perioperative data collection. Short acting opiate free spinal anaesthesia was administered with hunter’s canal block or saphenous block for TKR. Surgery consisted in short operating time, non-complex cases, Tranexamic acid + LIA
Results
87% of the patients had SDD while 13% needed overnight stay. Main reasons for failure to discharge were lack of confidence, fainting due to vasovagal episodes, urine retention, late resolution of spinal anaesthesia. 3 patients had readmission within 3 days, 4 patients within 6 weeks including 1 with a partial and treated pulmonary embolism. 98% patients were satisfied with SDD. After launching the day case arthroplasty program, average LOS of inpatients was reduced from 2.4 days to 1.4 days and rate of discharge with only 1-night stay increased from 12% to around 70%.
Authors
Marco La Malfa
Barlborough Hospital, Barlborough, United Kingdom
Gyorgy Lovasz
Barlborough Hospital, Barlborough, United Kingdom
Attila Aros
Barlborough Hospital, Barlborough, United Kingdom
Ferenc Toth
Barlborough Hospital, Barlborough, United Kingdom