Yoeri Bemelmans

General introduction 11 1 Traditions were thereby ceased; patients were no longer obligated to be in hospital for more than 2 days, based on their medical conditions. To facilitate early mobilisation (and thereby early achievement of these discharge criteria), urinary catheters and closed-suction drainage were no more used on a regular basis but only in case of an adverse course or in patients with pre-existing comorbidities. One of the most remarkable optimisations can be seen in the usage of tranexamic acid (TXA) perioperatively [15,16]. It reduced allogenic blood transfusion dramatically and ruled out the arguments to use autologous blood (re)transfusion via closed-suction drains. Fast-track surgery pathways are characterised by the multidisciplinary approach to patient care with use of evidence-based protocols [5]. The multidisciplinary team consist of surgeons, anaesthesiologists, hospital pharmacist, nursing staff and physiotherapists on the medical basis, coordinated by a professional project leader and person of contact, such as a physician assistant. Other specialities are involved as well on the more practical side of the process (e.g. managers, planners, secretaries, communication office). Success depends on the collaboration of these different entities as a total process. Outpatient joint arthroplasty With the ongoing improvement of the perioperative process and the further reduction in LOS of fast-track surgery programs, outpatient joint arthroplasty (OJA) becomes feasible. Substantiated with an increasing amount of evidence, these OJA pathways are extended to daily practice [17,18,19,20,21]. The introduction of OJA pathways was done on the basics of two major principles. Firstly, due to the growing trends in amounts of arthroplasties performed globally. As the global population ages, demand for hip and knee arthroplasty will rise. To cope with this demand, hospitals need to be equipped to treat high volumes of patients in the upcoming years. By reducing the LOS, the volume of arthroplasty procedures can be increased, substantiated with an optimisation of the complete arthroplasty process in the hospital (e.g. operation-room planning, improvement of surgery duration). Secondly, patient’s preferences should be taken into account. Although no precise evidence is available, it is assumed that patients prefer to recover in their own environment. OJA pathways encounter these preferences. Despite the growing trend and evidence of OJA, these pathways are at the beginning of their development [22]. Evidence-based guidelines on the selection of ‘appropriate’ patients should be investigated further [17,23]. With an aim to first improve the arthroplasty pathway, a safe and efficient reduction of LOS towards OJA can be made without compromising the postoperative outcomes in terms of (S)AEs and readmissions.