140 Variation in Day-Case Elective Surgery for Hip and Knee Replacements: A National Cross-Sectional Survey
Teesta Maulik, Amal Ahmed, Kamila Kutyla, Omar MusbahiAbstract
Aim
The escalating backlog of elective orthopaedic procedures, exacerbated by the pandemic and an ageing population, has spurred interest in day-case surgery as a potentially faster and safer alternative. Day-case surgery is typically defined as surgery that allows discharge on the same calendar day. A standardised guideline is currently unavailable and hospitals operate independently. This cross-sectional study aims to showcase the national variation in day-case total hip arthroplasty (THA) and total knee arthroplasty (TKA) protocols.
Methods
Between January and July of 2024, a cross-sectional survey was circulated to NHS Elective orthopaedic providers. Several domains in the questionnaire focused on high volume and low complexity hubs, arthroplasty nurses, criteria for day-case arthroplasty patient selection, anaesthesia, peri-articular injections and physiotherapy.
Results
Of 24 respondents, 83.3% had day-case pathways for hip or knee replacements. Of this, 15.0% defined 'day-case' as discharge within 24 hours. Day-case procedures averaged 15.5% (±15.9%) of total arthroplasties, ranging from <1% to 60%. “Home Living situation” was the most common variable that influenced patient suitability for the day-case pathway. The most common peri-articular injections were tranexamic acid, adrenaline, and levobupivacaine with 62.5% (n = 16) using tranexamic acid in their protocol. 47% (n = 17) of physiotherapists saw patients both pre- and post-operatively on the operative day.
Conclusion
Hospital protocols for day-case lower limb arthroplasty vary widely. Further studies are required to assess the effects of this variation on hospital and patient-based outcomes.