Day-case or short-stay admission for arthroscopic knee surgery: a randomised controlled trial

Abstract

The Royal Colleges, The Audit Commission, and politicians have encouraged day-case care for patients undergoing arthroscopic knee surgery. However, there remains both public and professional concern regarding the acceptability and safety of this form of management, although there are clear economic benefits. In a prospective randomised controlled trial, 50 patients underwent arthroscopic surgery as a day-case and 50 patients were admitted overnight. Outcome was assessed by postal questionnaire 4 weeks after discharge. A linear visual analogue scale was used to measure pain levels. The response rate was 93%. The diagnoses and types of arthroscopic surgery were similar in both groups. In total, 94% of day-cases and 91% of patients admitted overnight expressed overall satisfaction. Pain after discharge was similar in both groups. Day-case management was preferred by 90% of day-case patients and by 64% of those admitted overnight. Of patients in the day-case group, 12% had to be admitted overnight because of recovery problems, but 7% of patients randomised to overnight stay discharged themselves. One patient admitted overnight required readmission because of a wound haematoma. Patients who had received day-case management returned to work significantly faster than those who had been admitted. Modern anaesthetic techniques with special attention to anti-emesis and pain control have reduced postoperative morbidity to acceptable levels. Provided that patients are properly selected and well informed, day-case care is preferable for the majority of patients undergoing arthroscopic surgery of the knee.