Yoeri Bemelmans

Chapter 6 88 Table 4. Continued. Author(s) N Arthroplasty Study design In-/exclusion criteria Kolisek et al. 2009 [22] 64 TKA Case controlled lived <1hrs from the office, who had an adult to help them at home / any history of diabetes, myocardial infarction, stroke, congestive heart failure, venous thrombo-embolism, cardiac arrhythmia, respiratory failure, or chronic pain requiring regulair opioid medications. Current study 40 UKA Case controlled severe cardiologic, pulmonary and/or internal diseases, not able to understand and complete the procedure due to cognitive dysfunction, fear to follow the outpatient procedure, not be discharged to their home environment. This single surgeon, case-controlled pilot study, with a limited number of patients, could raise questions about the general applicability. We agree with Berger et al. [4], based on the experience with the use of clinical pathways, a stepwise implementation of an enhanced pathway, with the aim to discharge patients on the day of surgery, will be more effective and safe. Once these changes have been put in place, it will often be necessary to re-evaluate the new structures, to explore and extend the roles of the multidisciplinary team, to ensure optimal pre-, peri- and postoperative care. On the other hand, expansion of a day care surgery pathway involves an extensive change inmindset, both for patients and dedicated multidisciplinary team. Health care organizations and hospital management needs to be convinced of the possibilities of optimised clinical pathways. With the use of simplified protocols and standards, wich are applicable in every hospital, each hospital is able to reducewaiting periods and length of hospital stay [28]. This could result in lower costs, with comparable or improved patient satisfaction. Obviously, there are some methodological limitations in order to say something about the AE’s beceause of the small number of patients included in this study. These results might be inappropriate to use to conclude that the amount of AE’s are comparable between both pathways. Further studies on AE’s as an outcome with sufficient power and sample size are needed to assess whether these outcomemeasures differs between both pathways.