Implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting
DOI:
https://doi.org/10.2340/17453674.2024.40185Keywords:
Arthroplasty, Hip, Implementation, KneeAbstract
Background and purpose: Length of hospital stay after hip and knee arthroplasty is about 1 day in Denmark with few patients discharged on the day of surgery. Hence, a protocol for multicenter implementation of discharge on day of surgery has been instituted. We aimed to describe the implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting.
Methods: We performed a prospective multicenter study from 7 public hospitals across Denmark. Patients were screened using well-defined in- and exclusion criteria and were discharged on day of surgery when fulfilling functional discharge criteria. The study period was from September 2022 to February 2023 with variable start of implementation. Data from the same centers in a 6-month period before the COVID pandemic from July 2019 to December 2019 was used for baseline control.
Results: Of 2,756 primary hip and knee arthroplasties, 37% (95% confidence interval [CI] 35–39) were eligible (range 21–50% in centers) and 52% (range 24–62%) of these were discharged on day of surgery. 21% (CI 20–23) of all patients (eligible and non-eligible) were discharged on day of surgery with a range of 10–31% within centers. This was an additional 15% (CI 13–17, P < 0.001) compared with patients discharged in the control period (6% in 2019).
Conclusion: We found it possible to perform outpatient hip and knee replacement in 21% of patients in a public healthcare setting, probably to be increased with further center experience.
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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.arth201612040. DOI: https://doi.org/10.1016/j.arth.2016.12.040
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
Mantel J, Ruppenkamp J W, Cantu M, Holy C. Total knee arthroplasty in the outpatient vs inpatient settings: impact of site of care on early postoperative economic and clinical outcome. J Orthop Surg Res 2023; 4; 18(1): 273. doi: 10.1186/s13018-023-03750-4. DOI: https://doi.org/10.1186/s13018-023-03750-4
Petersen P B, Kehlet H, Jorgensen C C, Knee Replacement Collaborative Group. Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017. Sci Rep 2020; 4; 10(1): 21233. doi: 10.1038/s41598-020-77127-6. DOI: https://doi.org/10.1038/s41598-020-77127-6
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
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
Coenders M J, Mathijssen N M C, Vehmeijer S B W. Three and a half years’ experience with outpatient total hip arthroplasty. Bone Joint J 2020; 102-B(1): 82-9. doi: 10.1302/0301-620X102B1BJJ-2019-0045R2. DOI: https://doi.org/10.1302/0301-620X.102B1.BJJ-2019-0045.R2
Lovasz G, Aros A, Toth F, Faye J V, Malfa M L. Introduction of day case hip and knee replacement programme at an inpatient ward is safe and may expedite shortening of hospital stays of traditional arthroplasties. J Orthop Surg Res 2021; 16(1): 585. doi: 10.1186/s13018-021-02737-3. DOI: https://doi.org/10.1186/s13018-021-02737-3
Parcells B W, Giacobbe D, Macknet D, Smith A, Schottenfeld M, Harwood D A, et al. Total joint arthroplasty in a stand-alone ambulatory surgical center: short-term outcomes. Orthopedics 2016; 39(4): 223-8. doi: 10.3928/01477447-20160419-06. DOI: https://doi.org/10.3928/01477447-20160419-06
Shi Y, Zhu P, Jia J, Shao Z, Yang S, Chen W, et al. Cost-effectiveness of same-day discharge surgery for primary total hip arthroplasty: a pragmatic randomized controlled study. Front Public Health 2022; 25(10): 825727. doi: 10.3389/fpubh2022825727. DOI: https://doi.org/10.3389/fpubh.2022.825727
Jensen C B, Troelsen A, Foss N B, Nielsen C S, Lindberg-Larsen M, Gromov K. 10-year evolution of day-case hip and knee arthroplasty: a Danish nationwide register study of 166,833 procedures from 2010 to 2020. Acta Orthop 2023; 94: 178-84. doi: 10.2340/17453674202311961. DOI: https://doi.org/10.2340/17453674.2023.11961
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/rcsann20207142. DOI: https://doi.org/10.1308/rcsann.2020.7142
Lindberg-Larsen M, Varnum C, Jakobsen T, Andersen M R, Sperling K, Overgaard S, et al. Study protocol for discharge on day of surgery after hip and knee arthroplasty from the Center for Fast-track Hip and Knee Replacement. Acta Orthop 2023; 94: 121-7. doi: 10.2340/17453674.2023.11636. DOI: https://doi.org/10.2340/17453674.2023.11636
Benchimol E I, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 2015; 12(10): e1001885. doi: 10.1371/journal.pmed1001885. DOI: https://doi.org/10.1371/journal.pmed.1001885
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/CLEPS91125. DOI: https://doi.org/10.2147/CLEP.S91125
Center for Fast Track – Hip and Knee Replacement. Available from: www.fast-track.health.
Berend K R, Lombardi A V, 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
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: 10.1080/1745367420171314158. DOI: https://doi.org/10.1080/17453674.2017.1314158
Goyal N, Chen A F, Padgett S E, Tan T L, Kheir M M, Hopper R H, et al. A multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clin Orthop Relat Res 2017; 475(2): 364-72. doi: 10.1007/s11999-016-4915-z. DOI: https://doi.org/10.1007/s11999-016-4915-z
Schmidt A M, Garval M, Gromov K, Holm C, Larsen J R, Runge C. 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: 10.2340/1745367420222807. DOI: https://doi.org/10.2340/17453674.2022.2807
Darrith B, Frisch N B, Tetreault M B, Fice M P, Culvern C N, Della Valle C J. Inpatient versus outpatient arthroplasty: a single-surgeon, matched cohort analysis of 90-day complications. J Arthroplasty 2019; 34(2): 221-7. doi: 10.1016/j.arth201810015. DOI: https://doi.org/10.1016/j.arth.2018.10.015
Verdier N, Boutaud B, Ragot P, Leroy P, Saffarini M, Nover L, et al. Same-day discharge to home is feasible and safe in up to 75% of unselected total hip and knee arthroplasty. Int Orthop 2022; 46(5): 1019-27. doi: 10.1007/s00264-022-05348-7. DOI: https://doi.org/10.1007/s00264-022-05348-7
Danish Knee Arthroplasty Register (DKR), 2021 (B) National Annual Report. Available from: URL: http://www.rkkp.dk.
Danish Hip Arthroplasty Register (DHR), 2021 (B) National Annual Report. Available from: URL: http://www.dhr.dk.
Joshi G P, Kehlet H. Enhanced recovery and same-day discharge hospital stay: speed versus safety? Br J Surg 2023; 110(12): 1644-5. doi: 10.1093/bjs/znad222. DOI: https://doi.org/10.1093/bjs/znad222
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.
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Copyright (c) 2024 Oddrún Danielsen, Claus Varnum, Christian Bredgaard Jensen, Thomas Jakobsen, Mikkel Rathsach Andersen, Manuel Josef Bieder, Søren Overgaard, Christoffer Calov Jørgensen, Henrik Kehlet, Kirill Gromov, Martin Lindberg-Larsen
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