Yoeri Bemelmans

Chapter 12 178 type of arthroplasty, estimated blood loss, perioperative Hb levels and length of stay) were statistically significant different between transfused and non-transfused patients. The incidence of thromboembolic adverse events (e.g. deep vein thrombosis/lung embolism) was acceptable low. Oneof themajor issues for prolongedhospital stay and/or delayedmobilization is severe postoperative pain. Multi-modal painmodalities are conducted to control postoperative pain which makes the patient able to mobilize hours after surgery, reduce (opioid) pain medication and thereby effectuate early discharge. The introduction of local infiltration analgesia (LIA) in knee arthroplasty is the most considerable contributor to adequate pain control after surgery. Several methods are described, with variety of analgesics used in themixture of LIA. Chapter 4 examined, via a randomized controlled trial, the effect of adrenaline in the LIA mixture. The postoperative pain scores and opioid consumption did not differ between patients who received LIA with or without adrenaline. To prevent for possible adrenaline-related side effects and maintaining the analgesic effect, omission of adrenaline from the LIA mixture is eligible. Postoperative urinary retention (POUR) is a challenging condition after hip and knee arthroplasty surgery. It requires preventivemeasures, adequatemonitoring and precise treatment if it does occur. Chapter 5 presents the results of a retrospective investigation of 803 patients, which showed 12.9%incidence of POUR after implementation of a nurse- led bladder scanprotocol. Patients characteristics and bladder volumes at different time- point throughout the surgical process (pre-, peri- and postoperative) were analysed, showing >200ml of bladder volume directly after surgery as a risk factor for POUR. Part two continues with safety and efficacy evaluations of outpatient joint arthroplasty (OJA). When introducing newly designed methods and treatment protocols, a pilot or case- controlled study can be conducted. Chapter 6 presents results of the first consecutive patients undergoing unicompartmental knee arthroplasty in an outpatient pathway. The outcomes, regarding safety (e.g. (serious) adverse events, readmissions) and efficacy (e.g. postoperative pain scores, postoperative nausea and vomiting (PONV), successful discharge on day of surgery) were compared with patients following the standard inpatient pathway. Postoperative pain was the most common reason for prolonged hospital stay for patients in the outpatient pathway group. Nevertheless, 85% of the patients went home on the day of surgery. Regarding efficacy, no significant differences were found for postoperative pain scores, numbers of patients with PONV and opiate usage during the first 2 days. Regarding safety, no differences were found