Yoeri Bemelmans

Patient selection criteria for outpatient hip and knee arthroplasty 127 8 and complete the procedure due to cognitive dysfunction (based onmedical history), fear of following the outpatient procedure, or thosewho couldnot be discharged to their home environment were also excluded. Pre-, peri- and post-operative protocols (e.g. type of anaesthesia, multi-modal painprotocol) were described byKort et al. [27], which included patients for unicompartmental knee arthroplasty (UKA). These protocols are the same protocols used for total hip arthroplasty (THA) and TKA. Local infiltration analgesia was onlyusedperioperative for TKAaccording toKerr andKohan [25]without adrenaline [36]. Results The search revealed 14 clinical studies describing the results of outpatient surgery in 109.233 arthroplasty patients, including 10 case series and 4 case–control studies. These studies onOJA consisted of 9 knee and 5 hip arthroplasty papers (Table 1). There were no prospective randomized controlled trials. The results fromthese studiesmostly consisted papers from the USA [20, 25]. The first studies on outpatient knee arthroplasty [4, 5, 1, 12, 15, 26–28, 30] concluded that the pathway was safe and effective. Low complication and readmission rates (0.7–8 %) were found, including a high percentage of discharge on the day of surgery (73.7–98.9 %) and cost reduction [30]. Studies on outpatient hip arthroplasty [2, 6, 10, 13, 16] resulted in similar outcome in pre-selected patients. Inclusion criteria In all of these studies, an extensive diversity of inclusion criteria were used. Most of the inclusion criteria used were the understanding, ability and willingness to participate in the outpatient procedure [2, 12, 16, 27]. Only primary arthroplasty patients were included in all these studies; additionally, Berger et al. [5, 6] included patients without a history of previous hip or knee surgery. Classification of patients according to the ASA was used as inclusion to select patients varying from ASA I–III [12, 15, 16]. Poorer health status (ASA > II) and bleeding disorder was associated with higher readmission rates and AEs (revision, infection, mortality, deep vein thrombosis (DVT) and wound complications) after both hip and knee arthroplasty [7, 28]. Patients were operated if they were younger than 65 years of age [13] or ranging from 45 to 80 years [5, 6]. As previously found [27], a high age (>75 years) was a risk factor for postoperative falls, knee stiffness, pain and urinary retentionwith an increased readmission risk at 1 year postoperative. Inparticular, patients >80 years of age were at even at higher risk for falls [hazard ratio (HR) 2.06] and readmissions (HR 1.27), which can increase AEs [28]. Therefore, health status and age should be consideredwhen selecting patients for OJA. Preoperative cardiac examination was performed if patients had a history of a cardiovascular disease [15]. Besides transient postoperative hypotension [13], which led todelayeddischarge, no cardiovascular-related