Yoeri Bemelmans

Outpatient unicompartimental knee arthroplasty 77 6 Introduction Care pathways in orthopedic surgery are designed to prepare and optimise patients before, during, and after surgery. These pathways improve the quality of the patient’s care ensuring reduction of surgical stress, PONV and pain, [16-19, 21] with increased patient satisfaction whilst reducing the length of stay [17]. Slowly but surely, orthopedic surgeons are convinced of revolutionary changes on evidence-based interventions within the elective knee arthroplasty [16-19, 21]. Success requires the implementation of a clear pathway applying a selected number of scientifically supported procedures, used together and implemented in amultimodal care pathway [15, 19, 20, 33]. Outpatient surgery (OS) pathways are designed for patients initiated for elective surgery on the day of admission into the hospital with a planned discharge, without an overnight stay in a hospital bed [32]. OS is commonly used for small elective surgical procedures, but may be used for more complex and challenging cases. For example, knee arthroplasty, which is more common in the United States of America (USA) than in Europe [31]. Due to the ageing of the population and the implantation of prosthesis in younger patients, the number of knee joint replacement surgeries in Western countries are increasing strongly [26]. The number of joint arthroplasties in the USA in 2006 was estimated at 600.000 operations [9]. This number of operations will even increase with 134% in 9 years [23]. Due to the advancement of multidisciplinary pathways, outpatient UKA is allowing more surgical procedures to be performed; a cost reduction should be possible [3, 30].On the other hand, health care organizations create strategies to decline the use of resources, with the preservation of the quality of care [27]. In2011 optimisationof the conventional pathway [28] resulted intoanenhanced recovery pathway for knee arthroplasty. After years of experience, this optimisation resulted in an OS pathway for UKA. OS is accomplished by a patient specific approach, an optimised process inwhich the individual proactive patient is essential. Recent literature supports early discharge on the day of operation [4,8,10,13,22]. Published results on outpatient knee arthroplasty are rare and only consist papers from the USA. Europe is more conservative to change care pathways and/or healthcare systems. At the moment optimised enhanced recovery programs still needs to be implemented in most of the orthopedic departments around Europe, since the literature on enhanced recovery for knee arthroplasty mostly included literature from the scandinavian countries. Further research needs to be done to emphasize the effectiveness and safety of outpatient pathways in patients undergoing UKA with the use of generally applicable protocols.