Discharge on the day of surgery following unicompartmental knee arthroplasty within the United Kingdom NHS
2017
Aims Unicompartmental knee arthroplasty (UKA) has been successfully
performed in the United States healthcare system on outpatients.
Despite differences in healthcare structure and financial environment,
we hypothesised that it would be feasible to replicate this success
and perform UKA with safe day of surgery discharge within the NHS,
in the United Kingdom. This has not been reported in any other United
Kingdom centres. Patients and Methods We report our experience of implementing a pathway to allow safe
day of surgery discharge following UKA. Data were prospectively
collected on 72 patients who underwent UKA as a day case between
December 2011 and September 2015. Results A total of 61 patients (85%) were discharged on the same day.
The most common reason for failure was logistical; five patients
had their operation too late in the day. Three patients failed to
mobilise safely, two had inadequate control of pain and one had
a leaking wound. The mean length of stay for those who were not
discharged on the same day was 1.2 nights (1 to 3). During the same
time, 58 patients underwent planned inpatient UKA, as they were deemed
inappropriate for discharge on the day of surgery. However, three
of these were safely discharged on the same day. Follow-up data, 24 hours post-operatively, were available for
70 patients; 51 (73%) reported no or mild pain, 14 (20%) had moderate
pain and five (7%) had severe pain. There were no re-admissions.
All patients had a high level of satisfaction. Conclusion We found that patients can be safely and effectively discharged
on the day of surgery after UKA, with high levels of satisfaction.
This clearly offers improved management of resources and financial
savings to healthcare trusts. Cite this article: Bone Joint J 2017;99-B:788–92.
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