Maya Matsumoto1, Sean Saito2, Samantha Andrews3, Kristin Mathews4, Landon Morikawa1, Cass Nakasone5. 1. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI 96813, USA. 2. John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI 96813, USA. 3. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA; University of Hawai'i, Department of Surgery, 1356 Lusitana Street, Honolulu, HI 96813, USA. Electronic address: samantha.andrews@straub.net. 4. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA. 5. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA; University of Hawai'i, Department of Surgery, 1356 Lusitana Street, Honolulu, HI 96813, USA.
Abstract
BACKGROUND: Evidence suggests that only a minority of unselected patients are able to achieve same day (SD) discharge following unilateral unicompartmental knee arthroplasty (UKA). However, many hospitals continue to classify UKA as an outpatient procedure, creating financial pressure to limit prolonged hospitalizations. To understand and address challenges that decrease patients' likelihood of achieving SD discharge, this study aimed to identify barriers commonly contributing to SD discharge failures with following a rapid discharge protocol (RDP). METHODS: Retrospectively collected data from 158 unselected patients having undergone unilateral UKA between 2018 and 2019 were reviewed. All patients were treated using an established RPD with intended SD discharge. RESULTS: Successful SD discharge was achieved by 84.2% of patient. Overall, those failing to achieve SD discharge were older (p < 0.001), more commonly female (p = 0.037), have multiple functional deficits (p < 0.05) and experience post-operative nausea (p < 0.001). Increased age, the use of an assisted device, and post-operative nausea accounted for 44.8% of the variability for patient not achieving SD discharge. The model was able to classify 95.7% of SD discharge and 38.1% of unsuccessful SD discharge patients, for an overall success rate of 85.1%. CONCLUSIONS: The use of a well-developed, interdisciplinary RDP for unilateral UKA results in high SD discharge success in a community hospital setting. However, with 15.8% of patients still not able to achieve SD discharge, a more efficient RDP may include prioritizing patient scheduling, with lower priority given to older individuals requiring an assisted device, and changes to preventative and symptomatic treatment options for post-operative nausea.
BACKGROUND: Evidence suggests that only a minority of unselected patients are able to achieve same day (SD) discharge following unilateral unicompartmental knee arthroplasty (UKA). However, many hospitals continue to classify UKA as an outpatient procedure, creating financial pressure to limit prolonged hospitalizations. To understand and address challenges that decrease patients' likelihood of achieving SD discharge, this study aimed to identify barriers commonly contributing to SD discharge failures with following a rapid discharge protocol (RDP). METHODS: Retrospectively collected data from 158 unselected patients having undergone unilateral UKA between 2018 and 2019 were reviewed. All patients were treated using an established RPD with intended SD discharge. RESULTS: Successful SD discharge was achieved by 84.2% of patient. Overall, those failing to achieve SD discharge were older (p < 0.001), more commonly female (p = 0.037), have multiple functional deficits (p < 0.05) and experience post-operative nausea (p < 0.001). Increased age, the use of an assisted device, and post-operative nausea accounted for 44.8% of the variability for patient not achieving SD discharge. The model was able to classify 95.7% of SD discharge and 38.1% of unsuccessful SD discharge patients, for an overall success rate of 85.1%. CONCLUSIONS: The use of a well-developed, interdisciplinary RDP for unilateral UKA results in high SD discharge success in a community hospital setting. However, with 15.8% of patients still not able to achieve SD discharge, a more efficient RDP may include prioritizing patient scheduling, with lower priority given to older individuals requiring an assisted device, and changes to preventative and symptomatic treatment options for post-operative nausea.
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