Investigating Patient And Surgical Factors Affecting Same Day Discharge After Unicompartmental Knee Replacement

Investigating Patient And Surgical Factors Affecting Same Day Discharge After Unicompartmental Knee Replacement

Suleyman Ulla, MBChB, UNITED KINGDOM Patrick Richard Michael Nicholas, MBChB, MRCS(Glasg), UNITED KINGDOM Stuart Wilson Bell, MBChB MRCP FRCS (Orth), UNITED KINGDOM

Queen Elizabeth University Hospital, Glasgow, UNITED KINGDOM


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Anatomic Location

Anatomic Structure

Diagnosis / Condition

Treatment / Technique

Patient Populations

Diagnosis Method


Summary: Prolonged bed stay post-operatively can lead to increased morbidity and complications. This study aims to identify patient and surgical factors affecting same-day discharge following unicompartmental knee replacement.


Introduction

Prolonged bed stay post-operatively can lead to increased morbidity and complications. This study aims to identify key predictors of same-day discharge following medial unicompartmental knee arthroplasty (UKA).

Methods

A total of 92 patients who underwent medial UKA at a single elective surgical centre by 6 different surgeons was prospectively evaluated over 14 months. Data was extracted from clinical software. Data on whether same day discharge (SDD) was achieved was compared with patient and surgical factors. These were age, sex, post-operative haemoglobin (Hb), tourniquet use, surgical time, intra-operative blood loss, mobilisation status on day zero (>3 metres of walking), tranexamic acid (TXA) use, cemented or uncemented implant and discharge pain score.

Results

30% (N=28) patients were female. The mean age was 65 years old. Post-operative Hb was recorded for 33 patients (x̄=132). A tourniquet was used for all patients. Surgical time was recorded for 91 patients (x̄=65 minutes). Minimal blood loss was recorded for all operations. 59 patients were mobilised on day zero. TXA use was recorded for 71 patients. 44 patients received intra-articular and intravenous (IV) TXA and 27 patients received only IV TXA. 75 patients received uncemented implants. The mean discharge pain score was 1.7 for patients with SDD and 2.7 for patients that failed SDD. 43 patients achieved SDD.

Fisher’s exact test and multivariable logistic regression analysis was performed, statistical significance was set as p < 0.05. Mobilisation status on day zero, age and sex were the statistically significant variables.

Conclusion

Mobilisation on day zero, age and sex have the greatest influence on SDD. To increase SDD, we advocate for prioritisation of early mobilisation and targeted interventions for female patients and older patients in UKA peri-operative pathways.

Clinical relevance
This study highlights the key factors in achieving SDD after UKA, providing actionable insights for peri-operative care protocols.