Introduction Some orthopedic procedures have been performed on an outpatient basis for a long time, while others, more complex, have only recently become common. The aim of the study was to assess the relevance and efficiency of outpatient arthroplasties performed in a public hospital. Material and method The methodology was based (1) preoperatively on anesthesia consultation (patient eligibility, type of anesthesia, perioperative instructions and consultation with the coordinating nurse; (2) day of surgery on preemptive analgesia before surgery, administration of tranexamic acid, ultrasound-guided PENG block (hip), periarticular infiltration; and (3) postoperatively on catheter in the adductor canal (knee) and continuation of analgesics. Discharge criteria included pain control, absence of immediate complications, and ability to climb stairs. Home follow-up was conducted by a nurse and the coordinating nurse, with hemoglobin measurement. Results Between January 2021 and March 2024, 142 knee arthroplasties (93 TKA, 49 UKA) and 151 THA were performed on an outpatient basis, representing 14% and 17.4% of all knee and hip arthroplasties performed during the same period. The outpatient failure rate was 10.6% for knee (n=15) and 18.5% for hip (n=28). The causes of failure were pain (n=7), dizziness upon standing (n=9), motor block (n=9), organizational problems (n=6), bleeding (n=1), failure to adhere to fasting guidelines (n=3), refusal to leave the hospital (n=1), and medical complications (n=1). 31 patients (11 knee, 20 hips) (72%) were discharged on postoperative day 1. Discussion and conclusion Subject to patient selection, it is possible to perform hip and knee arthroplasties on an outpatient basis in a public hospital, with similar quality of results, patient satisfaction rates, and complication rates to those obtained with conventional hospitalization. The clinical pathway details all the steps of patient care, from the consultation with the surgeon to postoperative home follow-up by the coordinating nurse. This outpatient care is the culmination of the enhanced recovery after surgery (ERAS) approach.
Bizot et al. (Thu,) studied this question.