Programs referred to as Fast-Track/Rapid Recovery/Enhanced Recovery After Surgery have proven both effective and safe, particularly in joint replacement surgery. To the degree where same-day discharge (SDD) has been attempted in carefully selected cases at specialized outpatient units.
The patients included in the SDD trial were solely based on logistics, as all the procedures were medial PKRs, designated the first morning slots, and performed by one single-surgeon. 33 cases were included in this open clinical trial and strict postoperative criteria, based on vital parameters, urinary function, bleeding and mobilisation, had to be met before discharge was considered. All patients taking part were informed prior to surgery by a multidisciplinary team that they were likely to be discharged later that day. The SDD rate, patient satisfaction, number of outpatient visits, adverse events and readmissions within 90 days were evaluated.
29 of 33 (88%) successfully achieved SDD. All the patients below 80 years of age achieved SDD, whereas 43% of those at and over 80 years old were able to be discharged that day. An overall satisfaction rate of 93% was reached. Only 8% extra outpatient visits were required, all occurring within the first 2 weeks, which is consistent with routine practice. One plausible transient ischemic attack and one readmission caused by a penetrating trauma not affecting the knee were identified, both of which happened 10 weeks after surgery. No adverse events or readmissions occurred within the first 48 hours of surgery.
Although the sample group was relatively small, and the authors caution the “statistical significance should be evaluated with caution” they concluded that “this study clearly demonstrates that, same-day partial knee replacement surgery may be both feasible as a routine practice and safe for everyone”.