Same Day Joint Replacement Surgery: Patient Selection and Perioperative Management

Catherine Vandepitte; Letitia Van Pachtenbeke; Imré Van Herreweghe; Rajnish K Gupta; Nabil M Elkassabany

doi:10.1016/j.anclin.2022.04.003

Same Day Joint Replacement Surgery: Patient Selection and Perioperative Management

Anesthesiol Clin. 2022 Sep;40(3):537-545. doi: 10.1016/j.anclin.2022.04.003. Epub 2022 Jul 12.

Authors

Catherine Vandepitte¹, Letitia Van Pachtenbeke², Imré Van Herreweghe³, Rajnish K Gupta⁴, Nabil M Elkassabany⁵

Affiliations

¹ Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium.
² Department of Anesthesiology, Ziekenhuis Oost-Limburg (ZOL), Schiepse Bos 6, Genk 3600, Belgium.
³ Department of Anesthesiology, AZ Turnhout, Rubensstraat 166, 2300 Turnhout, Belgium.
⁴ Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive 4648, The Vanderbilt Clinic (TVC), Nashville, TN 37232-5614, USA. Electronic address: https://twitter.com/SportsDoc2009.
⁵ Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104, USA. Electronic address: Nabil.Elkassabany@uphs.upenn.edu.

PMID: 36049880
DOI: 10.1016/j.anclin.2022.04.003

Abstract

Joint replacements are increasingly performed as outpatient surgeries. The push toward ambulatory joint arthroplasty is driven in part by the changing current health care economics and reimbursement models. Patients' selection and well-designed perioperative care pathways are critical for the success of these procedures. The rate of complications after outpatient joint arthroplasty is comparable to the rate of complications in the ambulatory setting. Patient education, adequate social support, multimodal analgesia, regional anesthesia are key ingredients to the ambulatory care pathway after joint arthroplasty. Motor sparing nerve blocks are often used in these settings. Implementation of the elements of fast protocols can result in overall improvement of outcome metrics for all patients undergoing joint arthroplasty, including reduced length of stay and increased rate of home discharge.

Keywords: Ambulatory surgery; Hip arthroplasty; Hip replacement; Knee arthroplasty; Knee replacement; Outpatient surgery; Patient selection.

Publication types

Review

MeSH terms

Ambulatory Surgical Procedures
Analgesia* / methods
Arthroplasty, Replacement*
Arthroplasty, Replacement, Hip* / methods
Arthroplasty, Replacement, Knee* / methods
Humans
Length of Stay
Patient Discharge
Patient Selection