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. 2009 Jun;467(6):1443-9.
doi: 10.1007/s11999-009-0736-7. Epub 2009 Feb 24.

The feasibility and perioperative complications of outpatient knee arthroplasty

Richard A Berger  1 , Sharat K Kusuma, Sheila A Sanders, Elizabeth S Thill, Scott M Sporer
Affiliations

The feasibility and perioperative complications of outpatient knee arthroplasty

Richard A Berger et al. Clin Orthop Relat Res. 2009 Jun.

Abstract

The duration of hospitalization and subsequent length of recovery after elective knee arthroplasty have decreased. We hypothesized same-day discharge following either a unicompartmental (UKA) or total knee arthroplasty (TKA) in an unselected group of patients would not result in a higher perioperative complication rate than standard-length hospitalization when following a comprehensive perioperative clinical pathway, including preoperative teaching, regional anesthesia, preemptive oral analgesia, preemptive antiemetics, and a rapid rehabilitation protocol. We prospectively followed 111 of all 121 patients who had primary knee arthroplasty completed by noon and who agreed to be followed prospectively; 25 had UKA and 86 TKA. Of the 111 patients, 104 (94%, 24 with UKA and 80 with TKA) met discharge criteria and were discharged directly to home the day of surgery. Nausea requiring additional treatment before discharge was the most common reason for a delay in discharge. There were four (3.6%) readmissions (all with TKA) and one emergency room visit without readmission (in a patient with a TKA) within the first week after surgery, while there were four subsequent readmissions (3.6%) and one additional emergency room visit without readmission within three months of surgery, all among patients undergoing TKA. There were no deaths, cardiac events, or pulmonary complications during this study. Outpatient knee arthroplasty surgery is feasible in a large percentage of patients yet early readmissions may be decreased with a prolonged hospitalization.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
Patients with a same day discharge following a rapid rehabilitation protocol following total and unicompartmental knee arthroplasty are shown in a flowchart. Note the perioperative reasons for overnight hospitalization.
Fig. 2
Fig. 2
Patients requiring readmission to the hospital following total and unicompartmental knee arthroplasty within the first week after surgery are shown in a flowchart.
Fig. 3
Fig. 3
Patients requiring readmission to the hospital following total and unicompartmental knee arthroplasty between the first week and three months after surgery are shown in a flowchart.
See this image and copyright information in PMC

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