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. 2023 Aug 22;4(8):621-627.
doi: 10.1302/2633-1462.48.BJO-2023-0043.R1.

Low readmission and reattendance rate in day-case total knee arthroplasties

William G Fishley  1   2 , Sarah Paice  1 , Haaris Iqbal  1 , Stephen Mowat  3 , Nicholas S Kalson  1   4 , Mike Reed  1   2 , Paul Partington  1 , Timothy G Petheram  1
Affiliations

Low readmission and reattendance rate in day-case total knee arthroplasties

William G Fishley et al. Bone Jt Open. .

Abstract

Aims: The rate of day-case total knee arthroplasty (TKA) in the UK is currently approximately 0.5%. Reducing length of stay allows orthopaedic providers to improve efficiency, increase operative throughput, and tackle the rising demand for joint arthroplasty surgery and the COVID-19-related backlog. Here, we report safe delivery of day-case TKA in an NHS trust via inpatient wards with no additional resources.

Methods: Day-case TKAs, defined as patients discharged on the same calendar day as surgery, were retrospectively reviewed with a minimum follow-up of six months. Analysis of hospital and primary care records was performed to determine readmission and reattendance rates. Telephone interviews were conducted to determine patient satisfaction.

Results: Since 2016, 301/7350 TKAs (4.1%) in 290 patients at our institution were discharged on the day of surgery. Mean follow-up was 31.4 months (6.2 to 70.0). In all, 28 patients (9.3%) attended the emergency department or other acute care settings within 90 days of surgery, most often with wound concerns or leg swelling; six patients (2.0%) were readmitted. No patients underwent a subsequent revision procedure, and there were no periprosthetic infections. Two patients (0.7%) underwent secondary patella resurfacing, and one patient underwent arthroscopic arthrolysis after previous manipulation under anaesthetic (MUA). Three patients (1.0%) underwent MUA alone. Primary care consultation records, available for 206 patients, showed 16 patients (7.8%) contacted their general practitioner within two weeks postoperatively; two (1.0%) were referred to secondary care. Overall, 115/121 patients (95%) telephoned stated they would have day-case TKA again.

Conclusion: Day-case TKA can be safely delivered in the NHS with no additional resources. We found low incidence of contact with primary and secondary care in the postoperative period, and high patient satisfaction.

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Conflict of interest statement

W. G. Fishley discloses the BOA/ORUK Research Fellowship grant, and the Zimmer Biomet/Northumbria Educational Fellowship grant. T. Petheram reports payment to provide education from Heraeus for a hip arthroplasty course. M. Reed declares grants or contracts from Stryker, Zimmer Biomet, Heraeus, Link, Depuy, Smith & Nephew, Implantcast, and Biocomposites (made to institution to support the Bone and Joint Infection Registry), from Heraeus (which makes the cement), and from Zimmer Biomet for an educational grant for a fellow within the team; consulting fees from Heraeus and Pharmacosmos; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Zimmer Biomet, Heraeus, Stryker, and Pharmacosmos, all of which is unrelated to this work.

Figures

Fig. 1
Fig. 1
Details of the enhanced recovery pathway followed for all total knee arthroplasty patients. IV, intravenous; MR, modified-release; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive Staphylococcus aureus; OD, omni die; PO, per os; PR, per rectum, VTE, venous thromboembolism.
See this image and copyright information in PMC

References

    1. Ben-Shlomo Y, Blom A, Boulton C, et al. London, UK. National Joint Registry; 2019; [21 July 2023]. The National Joint Registry 16th Annual Report 2019.https://reports.njrcentre.org.uk/2019 date last. accessed. - PubMed
    1. Ben-Shlomo Y, Blom A, Boulton C, et al. London, UK. National Joint Registry; 2020; [21 July 2023]. The National Joint Registry 17th Annual Report.https://reports.njrcentre.org.uk/2020 date last. accessed. - PubMed
    1. British Medical Association NHS backlog data analysis. [21 July 2023]. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pre... date last. accessed.
    1. Culliford D, Maskell J, Judge A, et al. Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. Osteoarthritis Cartilage. 2015;23(4):594–600. doi: 10.1016/j.joca.2014.12.022. - DOI - PubMed
    1. Scully RD, Kappa JE, Melvin JS. “Outpatient”-Same-calendar-day discharge hip and knee arthroplasty. J Am Acad Orthop Surg. 2020;28(20):e900–e909. doi: 10.5435/JAAOS-D-19-00778. - DOI - PubMed