Association Between Same-Day Discharge Total Joint Arthroplasty and Risk of 90-Day Adverse Events in Patients with ASA Classification of ≥3

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nithin C. Reddy ◽  
Heather A. Prentice ◽  
Elizabeth W. Paxton ◽  
Adrian D. Hinman ◽  
Abraham G. Lin ◽  
...  
Keyword(s):  
Adverse Events ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Asa Classification ◽  
Same Day Discharge

Does the Timing of the Second Surgery of a Staged Bilateral Total Joint Arthroplasty Affect the Rate of Hospital Adverse Events and Perioperative Outcomes?

2020 ◽  
Vol 35 (6) ◽  
pp. 1516-1520
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Carlos A. Higuera ◽  
Juan C. Suarez ◽  
Preetesh D. Patel ◽  
...  
Keyword(s):  
Adverse Events ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Perioperative Outcomes ◽  
Second Surgery

scholarly journals Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study

2022 ◽  
pp. rapm-2021-103189
Author(s):  
Edward Yap ◽  
Julia Wei ◽  
Christopher Webb ◽  
Kevin Ng ◽  
Matthias Behrends
Keyword(s):  
Cohort Study ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Outpatient Surgery ◽  
Joint Arthroplasty ◽  
Neuraxial Anesthesia ◽  
General Anesthesia Group ◽  
Increased Risk ◽  
Same Day Discharge

BackgroundNeuraxial anesthesia when compared with general anesthesia has shown to improve outcomes following lower extremity total joint arthroplasty. It is unclear whether these benefits are present in outpatient surgery given the selection of healthier patients.ObjectiveTo compare the effects of neuraxial versus general anesthesia on outcomes following ambulatory hip and knee arthroplasty.MethodsMulticentered retrospective cohort study in ambulatory hip or knee arthroplasty patients between January 2017 and December 2019. Primary endpoint examined 30-day major postoperative complications (mortality, myocardial infarction, deep venous thromboembolism, pulmonary embolism, stroke, and acute renal failure).ResultsOf 11 523 eligible patients identified, 10 003 received neuraxial anesthesia, while 1520 received general anesthesia. 30-day major complications did not differ between neuraxial anesthesia and general anesthesia groups (1.8% vs 2.3%; aOR=0.85, CI: 0.56 to 1.27, p=0.39). There was no difference in 30-day minor complications (surgical site infection, pneumonia, urinary tract infection; 3.3% vs 4.1%; aOR=0.83, CI: 0.62 to 1.14, p=0.23). The neuraxial group demonstrated reduced pain and analgesia requirements and had less postoperative nausea and vomiting (PONV). Median recovery room length of stay was shorter by 52 min in the general anesthesia group, but these patients were more likely to fail same day discharge (33% vs 23.4%; p<0.01).ConclusionAnesthesia type was not associated with an increased risk for complications. However, neuraxial anesthesia improved outcomes that predict readiness for discharge: patients had less pain, required less opioids, and had a lower incidence of PONV, thus improving the rate of same day discharge.Trial registration numberNCT04203732.

Team Approach: Same-Day Discharge of Patients Undergoing Total Joint Arthroplasty

JBJS Reviews ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e0176-e0176
Author(s):  
Alexander M. Crawford ◽  
Antonia F. Chen ◽  
Amirmehdi Sabeti ◽  
Jean F. Jay ◽  
Vivek M. Shah
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Team Approach ◽  
Same Day Discharge

scholarly journals A Literature-Based Resource for the Development of Outpatient Arthroplasty Patient Selection Criteria

2021 ◽  
Vol 11 ◽  
Author(s):  
Joseph Gondusky ◽  
Richard Pahapill ◽  
Christian Coulson
Keyword(s):  
Patient Selection ◽  
Total Joint Arthroplasty ◽  
Selection Criteria ◽  
Outpatient Setting ◽  
Joint Arthroplasty ◽  
Same Day Discharge ◽  
Patient Selection Criteria ◽  
Patient Optimization ◽  
Optimal Site

Total joint arthroplasty (TJA) is moving towards the outpatient setting. Teams must develop patient selection criteria to ensure appropriate candidates are treated at the optimal site of care.  Protocols and recommendations have been developed to aid care teams in developing patient selection criteria, but these come from multiple disparate sources.  We review the available literature on patient selection criteria and optimization in the outpatient TJA population, and synthesize this information into a workable format for care design.  We hope to provide a resource to stakeholders that can be tailored to their unique outpatient facility.    Keywords: Total joint arthroplasty, outpatient, same day discharge, selection criteria, patient optimization.

scholarly journals Corneal Abrasions in Total Joint Arthroplasty

2021 ◽  
Vol 12 ◽  
pp. 215145932110601
Author(s):  
Megan E. Young ◽  
Simon C. Mears ◽  
Ahmed B. Sallam ◽  
Riley N. Sanders ◽  
C. Lowry Barnes ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Arthroplasty ◽  
Total Joint Replacement ◽  
Rare Complication ◽  
Joint Arthroplasty ◽  
Lateral Decubitus Position ◽  
Improvement Project ◽  
Corneal Abrasion ◽  
Same Day Discharge ◽  
Lateral Decubitus

Introduction Corneal abrasion (CA) is the most common ocular complication in patients undergoing nonocular surgery. Corneal abrasions can be caused by a variety of mechanisms, the most common being drying of the cornea due to reduced tear secretions, loss of eyelid reflex, and the loss of pain recognition during surgery. Though CA heals well with eye lubricants, it can result in significant ocular pain and some cases may go on to develop ocular complications. With the current switch to outpatient total joint replacement, CA could potentially lead to discharge delays. Materials and Methods We examined the results of a quality improvement project to reduce CA during general anesthesia to determine the rates of CA during hip and knee total joint replacement. We compared rates of CA for 6 months before and 6 months after the intervention. Results A total of 670 hip and knee arthroplasty procedures were performed during this period. Two events of CA occurred, one occurred before and one after the intervention to decrease eye injuries. Both incidences occurred during total hip arthroplasty (THA) procedures with the patient in the lateral decubitus position and recovered without long-term deficit. Discussion Surgeons and anesthesiologists alike should be cognizant of this avoidable complication and take precaution to protect the eyes during surgery, especially during THA when the patient is placed in the lateral decubitus position. Conclusion Corneal abrasion during total joint arthroplasty is a rare complication and is infrequently addressed in the literature. CA is mostly self-limiting, however, but may lead to patient dissatisfaction and to delays if same-day discharge is attempted. Preventative measures and attentive care may help reduce the incidence of CA in patients undergoing total joint arthroplasty. The lateral decubitus position and longer surgeries times are risk factors for CA.

Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications

2017 ◽  
Vol 32 (9) ◽  
pp. S150-S156.e1 ◽  
Author(s):  
Alex Sher ◽  
Aakash Keswani ◽  
Dong-han Yao ◽  
Michael Anderson ◽  
Karl Koenig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Post Discharge ◽  
Same Day Discharge

Same-Day Discharge Following Total Joint Arthroplasty: Examining Trends, Discharge Dispositions, and Complications Over Time

Orthopedics ◽  
2020 ◽  
Vol 43 (4) ◽  
pp. 204-208
Author(s):  
Julien Clouette ◽  
Avinesh Agarwalla ◽  
Bheeshma Ravi ◽  
Rajiv Gandhi ◽  
Naomi Maldonado-Rodriguez ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Same Day Discharge ◽  
Over Time
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