Dedicated peri-operative pathway improved day case discharge rate for anterior cruciate ligament reconstructions

Eur J Orthop Surg Traumatol. 2019 Apr;29(3):639-644. doi: 10.1007/s00590-018-2326-4. Epub 2018 Nov 2.

Abstract

The authors proposed that a well-developed peri-operative pathway for anterior cruciate ligament (ACL) reconstructions improve day case discharge rate with high patient satisfaction. A prospective observational study was undertaken at a district general hospital in UK between August 2017 and April 2018. A dedicated multidisciplinary peri-operative pathway was developed and introduced in January 2018. All primary ACL reconstructions using hamstring grafts in adult patients were included. Primary outcome measure was day case discharge and secondary outcome measures were visual analogue score for pain (VASP), nausea and vomiting scale (NVS), patient satisfaction and 30-day readmission. Patients who underwent surgery before and after introduction of the pathway were in group 1 and group 2, respectively. There were 19 and 22 patients each in group 1 and 2. Age and gender were similar in both groups. Day case discharge rate was significantly better in group 2 (68.4% vs 95.5%, p = 0.02). There were no significant differences in VASP or NVS on day 0, 1 or 3. Patient satisfaction rates were better in group 2 (85.7% vs 100%, p = 0.13). There were no readmissions in both groups. The VASP on day 1 and day 3 post-operatively was significantly better in those who were discharged on the same day (66.8 vs 41.3, p = 0.02; 60.5 vs 34.9, p = 0.03). A well-developed dedicated peri-operative pathway improved day case discharge rate for ACL reconstructions. The pathway was safe and had a higher patient satisfaction rate.

Keywords: ACL reconstruction; ACLR pathway; Anterior cruciate ligament reconstruction; Day case ACL reconstruction.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction* / adverse effects
  • Female
  • Humans
  • Male
  • Pain, Postoperative / etiology
  • Patient Discharge / statistics & numerical data*
  • Patient Education as Topic
  • Patient Readmission
  • Patient Satisfaction
  • Perioperative Care / methods*
  • Postoperative Nausea and Vomiting / etiology
  • Prospective Studies