Summary
Ambulatory UKA surgery is possible for most patients
Abstract
Introduction. The reduction in length of stay (LOS) in orthopaedic surgery has been steady for several years. For the past 3 or 4 years in France, the trend towards outpatient surgery has been growing up, as it is a goal for hospital administration.
Hypothesis
Ambulatory UKA surgery is possible and safe for most patients.
Materials and methods. This is a prospective, continuous, mono-centric, single operator study on 65 UKAs. Were included all UKAs carried out between January 2014 and June 2015, meeting the following criteria: voluntary patients, supportive family environment, absence of comorbidity (oral anticoagulants, diabetes, obesity), ASA score < 3. Preoperatively, patients received: Dexamethazone: 2mg/10kg, Tranexamic acid 2gr, Cefazoline 2gr IV. All patients were operated on under general anaesthesia with the same technique: Alpina® uni prosthesis without tourniquet. The arthrotomy was closed after a capsular injection of a solution of 150mg Ropivacaïne + 30mg Ketoprofen. Patient discharge on the same day evening was authorised by both surgeon and anaesthesiologist. Three criteria were quantified: number of patients seen before the date of the first consultation for the removal of stitches (around day 12), visual pain scale (10 points scale) on the first 12 days, and the level of satisfaction at the one-month postoperative visit.
Results. Five patients out of 65 (7.7%) were not included in the ambulatory program during the initial consultation. Three patients out of 60 (5%) were not able to be discharged on the same day evening due to nausea and therefore remained hospitalized for one night. Thirteen patients (22%) were reviewed between D-1 and D-4, for a swelling knee and 5 (8.3%) for pain not controlled by level 1 and 2 analgesics. The pain reached level 6 ± 3 by the 2nd day and then dropped to 1 ± 2 by the 12th day. At 1 month, 51 patients (85%) were satisfied with their care. There were no general or local complications.
Discussion. Ambulatory UKA surgery is possible for most patients. The inclusion rate for ambulatory UKA was 88% for Berger RA in 2010, therefore very close to this study rate of 91%. Ambulatory care is not only a change in surgical and anaesthetic practice but a totally new management process involving all medical and non-medical contributors.
Conclusion. Ambulatory UKA surgery is possible and safe for most patients.