Yoeri Bemelmans

Chapter 8 128 AEs or readmissionswere reported in these serieswithout preoperative cardiac clearance. Nevertheless, patients with a history of heart failure were at higher risk for readmission [28]. On the other hand, patients with severe cardiologic comorbidities (ASA > II) were not included for OJA [2, 5, 6, 10, 12, 16, 26, 27]. Logistic factors such as surgery completed by noon [4] or living <1 h from the hospital [26] were used as inclusion criteria. In these studies, neither prolonged hospital stay nor readmissionswere documented based on these logistic factors. Support at home (partner or relative) during the first days after surgery and an adopted home environment was frequentlyperformed [12, 15, 16, 26, 27]. Dorr et al. [13]. reported ‘homeproblem’ as a reason for delayed discharge. However, exact insight information on these ‘home problems’ were not described. One of the reasons for fear of early discharge is the postoperative dependenceon someone else [5]; this fear cancausedelayeddischarge [27]. Nevertheless, a change in the mindset of the patient, in terms of an early discharge, is a key factor for prevention of prolonged hospital stay [27]. Therefore, preoperative screening and preparation of the home environment is crucial for preventing a prolonged hospital stay and should be considered as an inclusion criteria for OJA. Exclusion criteria As for the inclusion criteria, a wide range of criteria were reported in OJA studies. Two studies [4, 11] examined the feasibility of an outpatient knee arthroplasty pathway in an unselected group. Berger et al. [4] foundhigher readmission rateswithin thefirstweek (3.6 %) compared to preselected patients (0.0 %) in their previous series [5] during the same postoperative period. It was concluded that a more stringent screening process could prevent complications and subsequent readmissions [4]. This preoperative screening process has been studied before, in outpatient and short-stay TKA [28, 30]. Patients with poorer health status, older patients, inpatients, patients not receiving a femoral nerve block (FNB) and those with a history of heart failure were at higher risk for readmission. When reviewing the exclusion criteria in the OJA studies, only two AEs related to the cardiovascularand/orpulmonarysystemwerereported.Overall, patientswithcardiac (e.g. heart failure, history of myocardial infarction, arrhythmia) [5, 6, 10, 16, 26, 27], pulmonary (e.g. embolism, respiratory failure) [5, 6, 10, 26, 27] and poorly controlled comorbidities [2, 6] were excluded. Thismight be the reason for the low incidence of AEs and readmissions. On the other hand, outpatient or short-stayTKApatientswith a history of ischaemic heart disease were not at higher risk for postoperative AEs [28]. Nevertheless, postoperative myocardial ischaemia can prolong hospital stay [3, 21]. Kallio et al. [21] suggested that preoperative anaesthesia evaluation and treatmentmay improve postoperative outcome in diabetic patients. Pain, dizziness, general weakness and postoperative nausea and vomiting (PONV) were seen as clinical reasons for prolonged hospital staywhen patients