Yoeri Bemelmans

Chapter 6 80 discharge, physiotherapy in their home environment was started 14 days postoperative. All patients were seen at the outpatient clinic on day 4 and 14, and at the 6 weeks (wks) and 3 months (mth) postoperative. Patients were briefed on the overall discharge criteria (dry wound, general well-being, independent mobilization with crutches and if necessary walking stairs with crutches). The ward physician examined the discharge criteria. If there was any deterioration or a lack of progress in the function, the operating surgeon was consulted. All patients were contacted by telephone the first day after discharge by the ward physician. Twenty patients without severe cardiologic, pulmonary, internal diseases, and/ or cognitive dysfunction, who had been operated on by the same surgeon between December 2011 and November 2012 for UKA following the RR pathway, were randomly selected from this cohort (n=79). Beside the differences between both pathways as summarized in Table 2, pre-, peri- and postoperative procedures and pain protocol were identical in both groups as well as the completed operative and clinical reports. Table 2. Differences between both pathways extracted for pre-, peri- and postoperative care and discharge criteria. RR pathway OS pathway Preoperative Admission Night before/day of operation Day of operation Planned discharge <3 days postoperative Day of admission Perioperative Dexamethason No Yes, perioperative Tranexamic acid No Yes, perioperative Antibiotics prophylactic I.v. I.v. and oral Postoperative First mobilization <6hrs <4hrs Compression bandages 24hrs postoperative 8hrs postoperative, first 4 days postoperative elastic bandage Discharge criteria Knee flexion of 70 degrees Not assisted as discharge criteria Outcome AE’s were classified as patient related (e.g. pain, PONV), thrombo-embolic events (e.g. deep venous thrombosis; DVT) and wound disorders, surgical related (e.g. infection) and/or prosthesis related (e.g. loosening). Experienced pain, measured by a Numerical Rating Scale (NRS, 0 to 10, 10 being ‘worst pain’), and incidences of PONVwere evaluated