Surgeons in several countries have shown increasing interest in outpatient surgery for selected patients. While the safety of standardised outpatient Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA) has been well documented, there are concerns that patients discharged on the day of surgery (DOS) do not receive the same level of rehabilitation as patients that stay overnight. This may in turn impact negatively on their post-operative pain and functional outcomes. This study compared early pain levels and pain and functional outcomes at one-year between patients that were discharged on the DOS and those that remained in hospital overnight.1
This was a prospective cohort study of 261 consecutive patients scheduled for outpatient TKA (n = 126) or THA (n = 135). Forty seven (37%) of TKA patients and 45 (33%) of THA patients were discharged on the DOS. Those that were not discharged on the DOS were discharged the next day.
No between-group differences in patient reported outcomes measured using the Oxford Knee (OKS) and Oxford Hips Scores (OKS) were observed prior to surgery, or at 3 and 12-month follow-up. This suggests that the outcome of TKA and THA were not negatively impacted by DOS discharge.
With the exception of post-op day (POD) 2 in the TKA group, pain scores in the first seven days post-surgery did not differ statistically between the groups. Although not significant, a trend towards higher pain levels was observed POD 2 to 4 in the DOS TKA group. The authors attributed this observation to higher activity levels both pre- and post-discharge and/or lower compliance with pain medication in the DOS TKA group. They suggested that “generally lower pain scores following THA may explain why no differences were observed between the two THA groups.” The use of opioids as a “rescue analgesic” was also similar between the groups, indicating that DOS discharge does not lead to increased opioid use.
Finally, while satisfaction and willingness to have the same procedure under the same circumstances again were similar, a higher proportion of patients in the DOS discharge group (93% Vs 87%) responded that they were willing to undergo the same procedure again. This trend did not quite reach statistical significance (p = 0.05).
The authors concluded that “these findings support continuous utilization of outpatient TKA and THA in selected patients.”