Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients
- 28 February 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research®
- Vol. 467 (6), 1424-1430
- https://doi.org/10.1007/s11999-009-0741-x
Abstract
Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consectutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices. Thirty-eight patients required some additional intervention outside the pathway to resolve nausea, hypotension, or sedation prior to discharge. There were no readmissions for pain, nausea, or hypotension yet there was one readmission for fracture and nine emergency room evaluations in the three month perioperative period. This anesthetic and rehabilitation protocol allowed outpatient total hip arthroplasty to be routinely performed in these consectutive patients undergoing primary total hip arthroplasty. With current reimbursement approaches the modest savings to the hospital in length of stay may be outweighed by the additional costs of personnel, thereby making this outpatient system more expensive to implement. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.Keywords
This publication has 29 references indexed in Scilit:
- Total Joint ArthroplastyThe Journal of Bone & Joint Surgery, 2007
- Outpatient Total Knee Arthroplasty With a Minimally Invasive TechniqueThe Journal of Arthroplasty, 2005
- Effectiveness of clinical pathways for total knee and total hip arthroplastyLiterature reviewThe Journal of Arthroplasty, 2003
- Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health statusSurgical Endoscopy, 2002
- Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty?The Journal of Arthroplasty, 2000
- Impact of a clinical pathway and implant standardization on total hip arthroplasty: A clinical and economic study of short-term patient outcomeThe Journal of Arthroplasty, 1998
- Critical Pathways as a Strategy for Improving Care: Problems and PotentialAnnals of Internal Medicine, 1995
- Miniarthrotomy versus arthroscopic-assisted anterior cruciate ligament reconstruction with autogenous patellar tendon graftArthroscopy: The Journal of Arthroscopic & Related Surgery, 1993
- Comparison of Open and Endoscopic MeniscectomyPublished by Ovid Technologies (Wolters Kluwer Health) ,1984
- The effect of diagnostic and operative arthroscopy and open meniscectomy on muscle strength in the thighThe American Journal of Sports Medicine, 1983