Study protocol for discharge on day of surgery after hip and knee arthroplasty from the Center for Fast-track Hip and Knee Replacement

Authors

  • Martin Lindberg-Larsen Center for Fast-track Hip and Knee Replacement; Department of Orthopaedic Surgery and traumatology, Odense University Hospital and Svendborg https://orcid.org/0000-0002-4483-677X
  • Claus Varnum Center for Fast-track Hip and Knee Replacement; Department of Orthopaedic Surgery, Lillebaelt Hospital—Vejle https://orcid.org/0000-0002-0625-5691
  • Thomas Jakobsen Center for Fast-track Hip and Knee Replacement; Department of Orthopaedic Surgery, Aalborg University Hospital
  • Mikkel Rathsach Andersen Center for Fast-track Hip and Knee Replacement; Department of Orthopaedic Surgery, Copenhagen University Hospital, Herlev-Gentofte https://orcid.org/0000-0003-3405-7147
  • Kim Sperling Center for Fast-track Hip and Knee Replacement; Department of Orthopaedic Surgery, Næstved, Slagelse and Ringsted Hospitals
  • Søren Overgaard Center for Fast-track Hip and Knee Replacement; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg https://orcid.org/0000-0001-6829-4787
  • Torben Bæk Hansen Center for Fast-track Hip and Knee Replacement; University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West Jutland and Aarhus University https://orcid.org/0000-0003-1678-3612
  • Christoffer Calov Jørgensen Center for Fast-track Hip and Knee Replacement; Department of Anaesthesia, Hospital of Northern Zeeland, Hillerød https://orcid.org/0000-0001-6902-8181
  • Henrik Kehlet Center for Fast-track Hip and Knee Replacement; Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet https://orcid.org/0000-0002-2209-1711
  • Kirill Gromov Center for Fast-track Hip and Knee Replacement; Department of Orthopaedic Surgery, Hvidovre University Hospital, Denmark https://orcid.org/0000-0002-8114-5193

DOI:

https://doi.org/10.2340/17453674.2023.11636

Keywords:

Arthroplasty, daycase surgery, fast-track, guideline, Hip, Knee, multicenter, outpatient surgery

Abstract

Background and purpose: Limited data exists on the implementation process and safety of discharge on the day of surgery after primary hip and knee arthroplasty in a multicenter setting. We report our study protocol on the investigation of the feasibility, safety, and socioeconomic aspects following discharge on day of surgery after hip and knee arthroplasty across 8 fast-track centers.
Patients and methods: This is a study protocol for a prospective cohort study on discharge on day of surgery from the Center for Fast-track Hip and Knee Replacement. The collaboration includes 8 centers covering 40% of the primary hip and knee arthroplasty procedures undertaken in Denmark. All patients scheduled for surgery are screened for eligibility using well-defined inclusion and exclusion criteria. Eligible patients fulfilling discharge criteria will be discharged on day of surgery. We expect to screen 9,000 patients annually.
Duration and outcome: Patients will be enrolled over a 3-year period from September 2022 and reporting of results will run continuously until December 2025. We shall report the proportion of eligible patients and patients discharged on day of surgery as well as limiting factors. Readmissions and complications within 30 days are recorded with real-time follow-up by research staff. Furthermore, patient-reported information on willingness to repeat discharge on day of surgery, contacts with the healthcare system, complications, and workability is registered 30 days postoperatively. EQ-5D, Oxford Knee Score, and Oxford Hip Score are completed preoperatively and after 3 months and 1 year. Finally, outcome data will be used in the development of a prediction model for successful discharge on the day of surgery.

 

Downloads

Download data is not yet available.

References

Kehlet H. Fast-track hip and knee arthroplasty. Lancet 2013; 381(9878): 1600-2. doi: 10.1016/S0140-6736(13)61003-X. DOI: https://doi.org/10.1016/S0140-6736(13)61003-X

Petersen P B, Kehlet H, Jorgensen C C, Lundbeck Foundation Centre for Fast-track H, Knee Replacement Collaborative G. Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017. Sci Rep 2020; 10(1): 21233. doi: 10.1038/s41598-020-77127-6. DOI: https://doi.org/10.1038/s41598-020-77127-6

Andreasen S E, Holm H B, Jorgensen M, Gromov K, Kjaersgaard-Andersen P, Husted H. Time-driven activity-based cost of fast-track total hip and knee arthroplasty. J Arthroplasty 2017; 32(6): 1747-55. doi: 10.1016/j.arth.2016.12.040. DOI: https://doi.org/10.1016/j.arth.2016.12.040

Argenson J N, Husted H, Lombardi A Jr, Booth R E, Thienpont E. Global Forum: An international perspective on outpatient surgical procedures for adult hip and knee reconstruction. J Bone Joint Surg Am 2016; 98(13): e55. doi: 10.2106/JBJS.15.00998. DOI: https://doi.org/10.2106/JBJS.15.00998

Vehmeijer S B W, Husted H, Kehlet H. Outpatient total hip and knee arthroplasty. Acta Orthop 2018; 89(2): 141-4. doi: 10.1080/17453674.2017.1410958. DOI: https://doi.org/10.1080/17453674.2017.1410958

Meneghini R M. Introduction: Optimizing hip and knee arthroplasty in the COVID era. J Arthroplasty 2021; 36(7S): S45. doi: 10.1016/j.arth.2021.03.011. DOI: https://doi.org/10.1016/j.arth.2021.03.011

Wainwright T W. Enhanced recovery after surgery (ERAS) for hip and knee replacement: why and how it should be implemented following the COVID-19 pandemic. Medicina (Kaunas) 2021; 57(1). doi: 10.3390/medicina57010081. DOI: https://doi.org/10.3390/medicina57010081

Bemelmans Y F L, Keulen M H F, Heymans M, van Haaren E H, Boonen B, Schotanus M G M. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg 2022; 142(8): 1775-91. doi: 10.1007/s00402-021-03811-5.

Dey S, Gadde R, Sobti A, Macdonald N, Jacob J, Unnithan A. The safety and efficacy of day-case total joint arthroplasty. Ann R Coll Surg Engl 2021; 103(9): 638-44. doi: 10.1308/rcsann.2021.0066. DOI: https://doi.org/10.1308/rcsann.2021.0066

Gromov K, Kjaersgaard-Andersen P, Revald P, Kehlet H, Husted H. Feasibility of outpatient total hip and knee arthroplasty in unselected patients. Acta Orthop 2017; 88(5): 516-21. doi: 10.1080/17453674.2017.1314158. DOI: https://doi.org/10.1080/17453674.2017.1314158

Rozell J C, Ast M P, Jiranek W A, Kim R H, Della Valle C J. Outpatient total joint arthroplasty: the new reality. J Arthroplasty 2021; 36(7S): S33-9. doi: 10.1016/j.arth.2021.02.030. DOI: https://doi.org/10.1016/j.arth.2021.02.030

Schmidt A M, Garval M, Gromov K, Holm C, Larsen J R, Runge C, et al. Feasibility, safety, and patient-reported outcomes 90 days after same-day total knee arthroplasty: a matched cohort study. Acta Orthop 2022; 93: 509-18. doi: 10.2340/17453674.2022.2807. DOI: https://doi.org/10.2340/17453674.2022.2807

Wainwright T W. The current status of daycase hip and knee arthroplasty within the English National Health Service: a retrospective analysis of hospital episode statistics data. Ann R Coll Surg Engl 2021; 103(5): 324-31. doi: 10.1308/rcsann.2020.7142. DOI: https://doi.org/10.1308/rcsann.2020.7142

Bredgaard Jensen C, Troelsen A, Bang Foss N, Skovgaard Nielsen C, Lindberg-Larsen M, Gromov K. The 10-year evolution of day-case hip and knee arthroplasty: a nationwide registry study of 166,833 procedures from 2010–2020. Acta Orthop. Accepted March 2023.

Arndt K B, Varnum C, Lindberg-Larsen M, Jensen C B, Rasmussen L E. Readmissions and mortality after outpatient vs inpatient unicompartmental knee arthroplasty in Denmark: a propensity score matched study of 5,384 procedures. Knee 2022; 38: 50-5. doi: 10.1016/j.knee.2022.07.008. DOI: https://doi.org/10.1016/j.knee.2022.07.008

Wainwright T W, Memtsoudis S G, Kehlet H. Fast-track hip and knee arthroplasty … how fast? Br J Anaesth 2021; 126(2): 348-9. doi: 10.1016/j.bja.2020.09.038. DOI: https://doi.org/10.1016/j.bja.2020.09.038

Artz N, Elvers K T, Lowe C M, Sackley C, Jepson P, Beswick A D. Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskelet Disord 2015; 16: 15. doi: 10.1186/s12891-015-0469-6. DOI: https://doi.org/10.1186/s12891-015-0469-6

Berend K R, Lombardi A V Jr, Berend M E, Adams J B, Morris M J. The outpatient total hip arthroplasty: a paradigm change. Bone Joint J 2018; 100-B(1 Supple A): 31-5. doi: 10.1302/0301-620X.100B1.BJJ-2017-0514.R1. DOI: https://doi.org/10.1302/0301-620X.100B1.BJJ-2017-0514.R1

Gasbjerg K S, Hagi-Pedersen D, Lunn T H, Laursen C C, Holmqvist M, Vinstrup L O, et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ 2022; 376: e067325. doi: 10.1136/bmj-2021-067325. DOI: https://doi.org/10.1136/bmj-2021-067325

Nielsen N I, Kehlet H, Gromov K, Troelsen A, Husted H, Varnum C, et al. High-dose steroids in high pain responders undergoing total knee arthroplasty: a randomised double-blind trial. Br J Anaesth 2022; 128(1): 150-8. doi: 10.1016/j.bja.2021.10.001. DOI: https://doi.org/10.1016/j.bja.2021.10.001

Jorgensen C C, Pitter F T, Kehlet H, Lundbeck Foundation Center for Fast-track H, Knee Replacement Collaborative G. Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement. Br J Anaesth 2017; 119(2): 267-75. doi: 10.1093/bja/aex190. DOI: https://doi.org/10.1093/bja/aex190

Lex J R, Edwards T C, Packer T W, Jones G G, Ravi B. Perioperative systemic dexamethasone reduces length of stay in total joint arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 2021; 36(3): 1168-86. doi: 10.1016/j.arth.2020.10.010. DOI: https://doi.org/10.1016/j.arth.2020.10.010

Sun Q, Li J, Chen J, Zheng C, Liu C, Jia Y. Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials. BMJ Open 2019; 9(1): e024350. doi: 10.1136/bmjopen-2018-024350. DOI: https://doi.org/10.1136/bmjopen-2018-024350

Magill P, Hill J C, Bryce L, Martin U, Dorman A, Hogg R, et al. Oral tranexamic acid for an additional 24 hours postoperatively versus a single preoperative intravenous dose for reducing blood loss in total knee arthroplasty: results of a randomized controlled trial (TRAC-24). Bone Joint J 2021; 103-B(10): 1595-603. doi: 10.1302/0301-620X.103B10.BJJ-2020-2308.R1. DOI: https://doi.org/10.1302/0301-620X.103B10.BJJ-2020-2308.R1

Andersen L O, Kehlet H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth 2014; 113(3): 360-74. doi: 10.1093/bja/aeu155. DOI: https://doi.org/10.1093/bja/aeu155

Pu X, Sun J M. General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty: a meta-analysis. Medicine (Baltimore) 2019; 98(16): e14925. doi: 10.1097/MD.0000000000014925. DOI: https://doi.org/10.1097/MD.0000000000014925

Memtsoudis S G, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin E M, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med 2021; 46(11): 971-85. doi: 10.1136/rapm-2021-102750. DOI: https://doi.org/10.1136/rapm-2021-102750

Anger M, Valovska T, Beloeil H, Lirk P, Joshi G P, Van de Velde M, et al. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021; 76(8): 1082-97. doi: 10.1111/anae.15498. DOI: https://doi.org/10.1111/anae.15498

Lavand’homme P M, Kehlet H, Rawal N, Joshi G P, PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations. Eur J Anaesthesiol 2022; 39(9): 743-57. doi: 10.1097/EJA.0000000000001691. DOI: https://doi.org/10.1097/EJA.0000000000001691

Petersen P B, Kehlet H, Jorgensen C C, Lundbeck Foundation Centre for Fast-track H, Knee Replacement Collaborative G. Safety of in-hospital only thromboprophylaxis after fast-track total hip and knee arthroplasty: a prospective follow-up study in 17,582 procedures.

Thromb Haemost 2018; 118(12): 2152-61. doi: 10.1055/s-0038-1675641. DOI: https://doi.org/10.1055/s-0038-1675641

Slankamenac K, Graf R, Barkun J, Puhan M A, Clavien P A. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 2013; 258(1): 1-7. doi: 10.1097/SLA.0b013e318296c732. DOI: https://doi.org/10.1097/SLA.0b013e318296c732

Schmidt M, Schmidt S A, Sandegaard J L, Ehrenstein V, Pedersen L, Sorensen H T. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7: 449-90. doi: 10.2147/CLEP.S91125. DOI: https://doi.org/10.2147/CLEP.S91125

Gogenur I. Introducing machine learning-based prediction models in the perioperative setting. Br J Surg 2023; Jan 21: znac462. doi: 10.1093/bjs/znac462. Epub ahead of print. DOI: https://doi.org/10.1093/bjs/znac462

Bemelmans Y F L, Keulen M H F, Heymans M, van Haaren E H, Boonen B, Schotanus M G M. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg 2022; 142(8): 1775-91. doi: 10.1007/s00402-021-03811-5. DOI: https://doi.org/10.1007/s00402-021-03811-5

Nissen S K, Fournaise A, Lauridsen J T, Ryg J, Nickel C H, Gudex C, et al. Cross-sectoral inter-rater reliability of the clinical frailty scale: a Danish translation and validation study. BMC Geriatr 2020; 20(1): 443. doi: 10.1186/s12877-020-01850-y. DOI: https://doi.org/10.1186/s12877-020-01850-y

Physicians RCo. National Early Warning Score (NEWS) 2: standardising the assessment of acute-illness severity in the NHS. Updated report of working party 2017 [Available from: file:///C:/Users/iby8fi/AppData/Local/Temp/MicrosoftEdgeDownloads/20c21027-af83-489a-905b-0ff54dc6dff9/NEWS2%20final%20report_0_0.pdf.

Additional Files

Published

2023-03-20

How to Cite

Lindberg-Larsen, M., Varnum, C., Jakobsen, T., Andersen, M. R., Sperling, K., Overgaard, S., Hansen, T. B., Jørgensen, C. C., Kehlet, H., & Gromov, K. (2023). Study protocol for discharge on day of surgery after hip and knee arthroplasty from the Center for Fast-track Hip and Knee Replacement. Acta Orthopaedica, 94, 121–127. https://doi.org/10.2340/17453674.2023.11636

Issue

Section

Articles

Categories