Cass K Nakasone1, Dylan Combs2, Brian Buchner3, Samantha Andrews4. 1. Straub Medical Center, Bone and Joint Center, Honolulu, HI 96813, United States of America; University of Hawai'i, Department of Surgery, Honolulu, HI 96813, United States of America. 2. John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, United States of America. 3. Straub Medical Center, Hospitalist, Honolulu, HI 96813, United States of America. 4. Straub Medical Center, Bone and Joint Center, Honolulu, HI 96813, United States of America; University of Hawai'i, Department of Surgery, Honolulu, HI 96813, United States of America. Electronic address: samantha.andrews@straub.net.
Abstract
BACKGROUND: Unilateral unicompartmental knee arthroplasty (UKA) is considered an outpatient procedure, however, previous research has reported a wide success rate range for day of surgery (DOS) discharge. Previous rapid discharge protocols (RDPs) have focused on pain management and nausea control but are commonly done in outpatient facilities, limiting the generalizability to the community hospital setting. Therefore, this study compared the rate of successful DOS discharge after the implementation of a RDP compared to the previous standard discharge protocol (SDP) following unilateral UKA. METHODS: A retrospective chart review was completed for 174 unselected consecutive patients having undergone unilateral UKA between January 2016 and May 2018. The RDP was implemented in March 2017, with the addition of an arthroplasty dedicated hospitalist, a change to patient discharge expectations and a change to post-operative patient navigation. All other surgical and patient care procedures were identical for both groups. RESULTS: Evaluation included 89 patients in the SDP group and 90 patients in the RDP group. Successful DOS discharge rate increased significantly from 11.2% for the SDP group to 72.2% for the RDP group (p = 0.000). Two patients from each group were treated with antibiotics for stitch abscess and no patient sustained a major complication within 90 days. CONCLUSIONS: Small, significant changes applied in the current study resulted in a significant increase in success of DOS discharge. These procedures can be easily implemented in all settings and may be more representative of the discharge capabilities for non-selected patients seen in the community hospital setting.
BACKGROUND: Unilateral unicompartmental knee arthroplasty (UKA) is considered an outpatient procedure, however, previous research has reported a wide success rate range for day of surgery (DOS) discharge. Previous rapid discharge protocols (RDPs) have focused on pain management and nausea control but are commonly done in outpatient facilities, limiting the generalizability to the community hospital setting. Therefore, this study compared the rate of successful DOS discharge after the implementation of a RDP compared to the previous standard discharge protocol (SDP) following unilateral UKA. METHODS: A retrospective chart review was completed for 174 unselected consecutive patients having undergone unilateral UKA between January 2016 and May 2018. The RDP was implemented in March 2017, with the addition of an arthroplasty dedicated hospitalist, a change to patient discharge expectations and a change to post-operative patient navigation. All other surgical and patient care procedures were identical for both groups. RESULTS: Evaluation included 89 patients in the SDP group and 90 patients in the RDP group. Successful DOS discharge rate increased significantly from 11.2% for the SDP group to 72.2% for the RDP group (p = 0.000). Two patients from each group were treated with antibiotics for stitch abscess and no patient sustained a major complication within 90 days. CONCLUSIONS: Small, significant changes applied in the current study resulted in a significant increase in success of DOS discharge. These procedures can be easily implemented in all settings and may be more representative of the discharge capabilities for non-selected patients seen in the community hospital setting.
Authors: Tarik Bayoumi; Jelle P van der List; Lindsey V Ruderman; Hendrik A Zuiderbaan; Gino M M J Kerkhoffs; Andrew D Pearle Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-08-11 Impact factor: 4.114