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Outcomes of a Total Joint Arthroplasty Enhanced Recovery Program in a Community Hospital Setting
- Source :
- The Journal of arthroplasty. 36(7S)
- Publication Year :
- 2020
-
Abstract
- Background Same-day discharge (SDD) total joint arthroplasty (TJA) is increasingly popular, yet there remain concerns regarding patient safety, complication rates, and unforeseen overnight admission (failure to launch; FTL). The aim of this study is to retrospectively examine the outcomes of a large consecutive SDD-TJA series in the community hospital setting. Methods We retrospectively reviewed 1200 consecutive SDD-TJA candidates between March 2017 and December 2019 by 5 surgeons at a community hospital. Patient demographics, perioperative data including anesthesia type, and 30-day complications were evaluated, including FTL, infection, intraoperative fracture, postoperative periprosthetic fracture or dislocation, return to operating room, and unplanned postoperative care. Results We included 1200 SDD patients (582/618 total hip arthroplasty/total knee arthroplasty, mean age 62.1 years, 595 females, 605 males). Spinal anesthesia was more common than general anesthesia (1087 vs 113 patients). There were 85 FTLs (7.1%), of this cohort 58.8% were female, with a mean age of 62.4 years. General anesthesia increased the risk of FTL (odds ratio 2.93). Complications resulting in FTL included block-induced neuropraxia (32.1%), orthostatic hypotension (26.1%), urinary retention (19.0%), and nausea (13.1%). Sixteen patients were readmitted within 30 days (1.3%). Six patients returned to the operating room for periprosthetic fracture (4), wound dehiscence (1), and superficial surgical site infection (1). Conclusion SDD-TJA can be safely performed at community hospitals, but general anesthesia should be avoided to decrease risk of FTL. Inpatient programs may allow young surgeons to gain experience with SDD-TJA while retaining overnight admission as a safety net for their patients. Level of Evidence Level III (Prognostic).
- Subjects :
- Male
medicine.medical_specialty
Arthroplasty, Replacement, Hip
Outpatient surgery
Periprosthetic
Hospitals, Community
03 medical and health sciences
Orthostatic vital signs
0302 clinical medicine
Postoperative Complications
medicine
Humans
Orthopedics and Sports Medicine
Retrospective Studies
030222 orthopedics
business.industry
Urinary retention
Wound dehiscence
Perioperative
Odds ratio
Middle Aged
medicine.disease
Community hospital
Patient Discharge
Surgery
Female
medicine.symptom
business
Subjects
Details
- ISSN :
- 15328406
- Volume :
- 36
- Issue :
- 7S
- Database :
- OpenAIRE
- Journal :
- The Journal of arthroplasty
- Accession number :
- edsair.doi.dedup.....a68e0399e7a82cd50f9b2381171655c9