Yoeri Bemelmans

Chapter 6 76 Abstract Purpose There has been increasing interest in accelerated programs for knee arthroplasty.We examined the efficacy and safety of an outpatient surgery (OS) pathway in patients undergoing unicompartmental knee arthroplasty (UKA). Methods This case-controlled study evaluates patients operated for UKA in an OS pathway (n=20) compared to Rapid Recovery (RR), the current standard (n=20). We investigated whether patients could be discharged on the day of surgery, resulting in comparable or better outcome by means of adverse events (AE’s) in terms of pain (Numerical Rating Scale, NRS), incidences of postoperative nausea and vomiting (PONV) and opiate use (<48hrs postoperative), complication and readmission rates (<3mth postoperative). Patient reported outcomes measures (PROMS) were obtained pre- and 3mth postoperative. Results Postoperative pain (NRS >5) was the most common reason for prolonged hospital stay in the OS pathway. Eighty-five percent of the patients were discharged on the day of surgery, whereas 95% of the patients were discharged on postoperative day 3 in the RR pathway. Overall, median pain scores in both pathways did not exceed a NRS score of 5, without significant differences (RR vs. OS) in the number of patients with PONV (4 vs. 2) and opiate use (11 vs. 9) <48hrs postoperative. At 3mth postoperative, no significant differences were found for AE’s and PROMS between both pathways. Conclusions The results of this study illustrates that an OS pathway for UKA is effective and safe with acceptable clinical outcome. Well-established and adequate standardized protocols, in- and exclusion criteria and a change in mindset for both the patient and themultidisciplinary teamare the key factors for the implementation of anOS pathway. Keywords Outpatient surgery; Short-stay; Unicompartmental knee arthroplasty; Partial knee arthroplasty; Pain management