Yoeri Bemelmans

Summary, Nederlandse samenvatting 179 12 between outpatient and inpatients patients in terms of (serious) adverse events and/or readmission. Patient reported outcome measures (PROMs) improved equally between both groups. With the increased application of OJA pathways globally, evidence is growing. Chapter 7 shows the results of a systematic review with meta-analysis on studies comparing OJA with standard inpatient pathways in terms of safety and efficacy (e.g. (S)AEs, readmissions, successful same day discharge rates, PROMs and costs). A total of 41 studies met the inclusion criteria and were methodologically assessed. In general, patients who followed the outpatients pathway were younger, had a lower BMI and ASA class when comparedwith patients who followed the inpatient pathway. No statistically significant differences between outpatients and inpatients were found regarding the overall complication and readmission rates, and improvement in PROMs. OJA resulted in an average cost reduction of $6.797,02. Therefore, OJA pathways are as safe and effective as inpatient pathways in selected populations, with a potential reduction of costs. Considerable risk of bias in themajority of studies was found and should be taken into account. As outlined in the above-mentioned chapter, current literature mostly exists of papers including a selected group of patients for OJA pathways. In general, the younger and healthier patients are selected, since it is considered to be safer when starting with these OJA pathways. Adequate selection of patients for OJA is important to prevent for (serious) adverse events and readmissions. Chapter 8 reviewed the literature on these patient selection criteria and additional expert opinion-based selection criteria were established by interviewing different medical specialists. The described evidence- based patient selection criteria, supplementedwith expert opinions, provide a basis for outpatient joint arthroplasty and can be useful when selecting patients. After discharge, patients need to be physical active to prevent for complications (e.g. thrombo-embolic events) and to start the rehabilitation process. Chapter 9 examined patients’ physical activity during the first 6 weeks postoperative, comparing OJA with inpatient TKA surgery. Data was obtainedwith usage of an activitymonitor. The activity parameters recovered steeply during the first 4 postoperative days and continued to improve within both pathways. No differences were found between both pathways regarding physical activity, both cohorts of patients did not reach preoperative levels at 5 weeks postoperative. This study demonstrates that the early physical activity parameters of patients after TKA recover independently of the clinical pathway (inpatient vs. outpatient) they were treated in.