Abstract
PurposeIn recent years, duration of hospitalisation after knee arthroplasty has decreased and fast track and outpatient surgery protocols have been developed. Studies have shown that outpatient surgery is feasible, safe, and cost effective. However, the psychological well-being of patients undergoing outpatient surgery has never been described before. The purpose of this study was to investigate how patients experience outpatient surgery for unicompartmental knee arthroplasty (UKA), examining levels of anxiety and depression, satisfaction, and pain. It was hypothesized that the same-day discharge following UKA would not result in higher levels of anxiety and depression, compared to the standard fast-track surgery.MethodsThis case-controlled study included 20 patients undergoing UKA in an outpatient surgery setting and 20 patients undergoing the standard fast-track procedure. The Hospital Anxiety and Depression Scale (HADS, 0–42, lower is better) and numeric rating scales (NRS, 0–10) for pain and satisfaction were collected preoperatively, on the day of surgery, on the first, second, and seventh postoperative days and after 6 and 12 weeks. The Oxford Knee Score (OKS), the KOOS, EuroQoL-5D, and Net Promoter Score (NPS) were collected preoperatively and 3 months postoperatively.Results90% of patients in the outpatient surgery group were discharged on the day of surgery. At the first postoperative day, the median HADS score was significantly lower in the outpatient surgery group compared to the fast-track group (3 vs. 8, p = 0.02), the median NRS satisfaction score was significantly higher in the outpatient surgery group (8 vs. 5, p = 0.03), and no differences existed between both groups for the NRS pain scores. At 3 month follow-up, no significant differences in improvement scores existed between both groups for the HADS, the NRS scores, and for the OKS, KOOS, EuroQoL-5D, and NPS.ConclusionThe results of this study emphasize the feasibility of an outpatient surgery pathway in carefully selected UKA patients. The outpatient surgery pathway is safe, and clinical outcome, including levels of anxiety and depression, satisfaction, and pain, was similar in outpatient surgery patients compared to the standard fast-track patients.Level of evidenceCase-control study, Level III.
Highlights
Unicompartmental knee arthroplasty (UKA) was considered a surgical procedure requiring prolonged hospitalisation periods, but in recent years, the shortening of hospitalisation after unicompartmental knee arthroplasty (UKA) has gained considerable interest
Anaesthesiologists disagreed on the ASA classification of the patient, who had a history of cardiac events
It was decided on the OR that the patient had to stay for one night
Summary
Unicompartmental knee arthroplasty (UKA) was considered a surgical procedure requiring prolonged hospitalisation periods, but in recent years, the shortening of hospitalisation after UKA has gained considerable interest. The average reported length of stay in fast-track programs for UKA patients has already decreased to 1 day, with good results [23]. The introduction of outpatient surgery seemed like the logical step in attempting to further improve clinical outcome and shortening length of stay in UKA. Several authors have described the use of an outpatient surgery pathway in UKA and so far results have been very promising [1, 7, 9, 11, 21]. Incidence of adverse events, complications, and readmissions was low and rates were comparable to UKA patients operated on in a fast-track pathway [2, 7, 11, 21]
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