Yoeri Bemelmans

Chapter 6 84 Discussion Themost important findings of the present studywas that outpatient unicompartimental knee arthroplasty is effective and safe with good short term clinical results in selected patients, with comparable outcomes as patients operated in a conventional pathway. Only six papers studied the feasibility of an outpatient pathway for knee arthroplasty of which themethodological evidencewas poor (Table 4). These papers have considerable limitations including poorly presented details of their cohorts [4,13,10,22]. For example, only four studies provided data on in- and exclusion criteria and only the study of Kolisek et al. [22] included a control group. However, they all reported comparable outcome without significant worsened results, in terms of AE’s, readmission rates and prolonged hospital stay. This paper presents the preliminary results on elective UKA in an OS setting in The Netherlands. There are some contradictions about the definition of OS. Kolisek et al. [22] aimed to discharge patients <23hrs after surgery. As presented by theWHO [32], OS is defined as admission and discharge on the day of surgery, without an overnight stay in the hospital. Berger et al. [4, 5] operated patients in an outpatient pathway as the first surgeries of the day [5] or before noon [4]. Their pain protocol allows sufficient time for postoperative pain control. Therefore, these organisational aspects should be taken into account in order to prevent a prolonged hospital stay. Our results show that it is effective and safe to operate selected patients in an outpatient UKA pathway, as 85% of all the UKA patients were discharged on the day of surgery as scheduled, without increasedAE’s and readmission rateas compared toour conventional pathway. This was in linewith our expectations andwith previously published results by others, who also studied the feasibility and safety of outpatient knee arthroplasty (Table. 4). Cross et al. [8] reported that 100% of the patients operated for UKA (n=105) were directly discharged home on the day of surgery. Slightly less (93%) were discharged on the day of surgery with total knee arthroplasty (TKA) compared to 96% of the patients operated for UKA [4]. Recently, Gondusky et al. [13] published their prospective study comparing UKA patients in a pathway with a planned overnight stay (n=47) and one with a planned discharge on the day of surgery (n=160). They found that 100% of the patients were able to return home the evening of the day of surgery.