Yoeri Bemelmans

Patient selection criteria for outpatient hip and knee arthroplasty 129 8 were operated in an enhanced recovery pathway for joint arthroplasty [18]. Most reported reasons for prolonged hospital stay in outpatient literature also consisted of pain and PONV [4, 5, 13, 16, 27]. When using peripheral nerve blocks, no prolonged hospital stay or readmission due to uncontrolled pain was found after OJA [12]. Readmission rate was lower in patients receiving a FNB. However, the risk of pain after 1 year postoperative was significantly higher [28]. Protocols for OJA should focus on adequate analgesia and prevention for PONV [5,10, 11, 15, 27, 30]. Some papers excluded patients with DM (type I and II) [16, 26]. Diabetic patients were at higher risk for AEs after joint arthroplasty [21, 28, 29, 38]. Patients with a high body mass index—BMI (>40 m2/kg) were excluded [6]. Although there was no correlation between prolonged hospital stay and BMI in THA [18] or TKA [4] patients, Ibrahim et al. [20] concluded that a high BMI (>40 m2/kg) increases operative time and intraoperative blood loss in THA due to technical difficulties in obese patients. After TKA, obese patients (≥30 m2/kg) are at higher risk for deep infection and revision surgery [24]. Therefore, a high BMI of >30 m2/kg should be considered as a general exclusion criteria for arthroplasty and not specifically for OJA. Chronic opioid consumption prior to THA resulted in worse clinical outcome, opioid- induced hyperalgesia and prolonged hospital stay [34]. Since these patients need a more stringent analgesia treatment, it seems justified to exclude these patients from OJA for postoperative pain control [12, 26]. Evidence on arthroplasty after stroke is rare, and functional impairments due toneurologic deficits (e.g. Parkinson’s disease) are preferably treated in an enhanced recovery pathway [37]. Nevertheless, history of a stroke was reported as exclusion criterion [26]. In case of unavailability for homecare service [12] or discharge other than home environment [27], which were also applied as exclusion criteria, one needs to consider whether OJA is possible. On the other hand, dependent functional status (partial or total independency)was found tobe a risk factor for increased readmissions after THA [7]. Patients with difficulties with self-care tasks should be excluded from OJA [38]. The incidence of chronic renal disease is high (26–27 %) in patients undergoing joint arthroplasty [39]. A significantly higher risk for postoperative AEs was found in patients with moderate to severe chronic renal disease. In particular, there is a twofoldhigher risk ofmortality. Preoperative screening for renal function should be performed and risks for complications in patients with moderate to severe chronic renal disease shouldbediscussedwhenperforming elective joint arthroplasty, since these comorbidities (renal impairment and major systemic illness) were reported as exclusion criteria [12, 27, 30]. Postoperative cognitive dysfunction is frequently (20–40%) reported after joint arthroplasty [1]. Enhanced recovery programs may decrease the risk of this cognitive dysfunction [38]. One of the most important determinants for development of cognitive dysfunction is reduced preoperative cognitive capacity [31], which is used as exclusion criterion [15, 27].