November 14, 2013
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Study: Day-of-surgery discharge found effective for UKA patients using refined perioperative pathway

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Day-of-surgery discharges can be safe, efficient and increase patient satisfaction when using a refined perioperative pathway for appropriately selected patients who undergo unicompartmental knee arthroplasty, according to results of a recently published study.

“[Unicompartmental knee arthroplasty] UKA patients can be discharged on the day of surgery with a high satisfaction rate,” Steven Barnett, MD, from the Hoag Orthopedic Institute in Irvine, Calif., told Orthopedics Today. “This provides orthopedic surgeons with the ability to effectively treat these patients while minimizing cost associated with this procedure.

 

Steven Barnett

Barnett said surgeons at his institution recognized that UKA patients had less difficulty with pain management, decreased length of stay and achieved better results in physical therapy during hospitalization.

“This led us to begin managing these patients with a 23-hour overnight stay and eventually discharging them on the day of surgery,” Barnett said.

Barnett said within a 2-year to 3-year period, surgeons moved UKA patients from an inpatient setting to a day of surgery discharge after adopting techniques related to general and regional anesthesia, local soft-tissue infiltration and oral perioperative pain management.

Under this perioperative pathway, he and colleagues successfully discharged 160 consecutive UKA patients who were a mean of 65 years old with a mean American Society of Anesthesiology class of 1.8. The mean recovery room time was 121 minutes and no patients had uncontrolled pain or nausea that required an overnight stay. Patients had high satisfaction scores and researchers noted significant improvements in Knee Society Clinical Rating System scores.

“Our current algorithm is dependent upon patient education prior to surgery. Patients are instructed on crutch use, postoperative wound management, precautions, and [deep vein thrombosis] DVT prophylaxis at an extensive preoperative visit,” Barnett said. “Pain management on the day of surgery entails use of multimodal oral analgesics started prior to the procedure combined with both regional nerve blocks and peri-articular infiltration of a local anesthetic mixture. Activity limitations and weight bearing precautions are reinforced prior to discharge from the surgery center.”

Barnett said other surgeons performing UKA have adopted the pathway described in this study with success.

“The authors are confident that results will continue to be optimal and look forward to adapting these protocols to other arthroplasty procedures moving forward,” he said.

Reference:

Gondusky JS. J Arthroplasty. 2013;doi:j.arth.2013.08.021.
Disclosure: Barnett is a paid consultant for and is on the speaker’s bureau for Stryker and DePuy. Gorab is a paid consultant for and is on the speaker’s for DePuy.