Title : Investigating patient and surgical factors affecting same day discharge after unicompartmental knee replacement
Abstract:
Introduction: 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.
Methods: A total of 38 patients who underwent unicompartmental knee replacement at a single elective surgical centre by 8 different surgeons was prospectively evaluated over 5 months. Data was extracted from clinical software. Data on whether same day discharge was achieved post-operatively is compared with patient and surgical factors. These factors include: Gender, age, post-operative haemoglobin, tourniquet use, surgical time, intra-operative blood loss, mobilisation status post-operatively (>3 metres of walking), tranexamic acid use (TXA), cemented or uncemented, discharge pain score and same day discharge.
Results: The mean age was 66 years old. There were 16 female patients. Post-operative haemoglobin was recorded for 12 patients, the mean was 136. A tourniquet was used for all patients. Surgical time was recorded for 36 patients, the mean was 66 minutes. Blood loss was recorded for 35 operations, all were minimal. 26 patients were mobilised on the same day. TXA use was recorded for 30 patients. 16 patients received both intra-articular and intravenous (IV) TXA and 14 patients received only IV TXA. 31 patients had uncemented implants. The mean discharge pain score was 2.2 for patients with same day discharge and 3.3 for patients that failed same day discharge. 20 patients achieved same day discharge. Multivariate regression was performed. This model explains approximately 73% variance in same day discharge. Mobilisation status post-operatively is the only statistically significant variable (coefficient 0.7855, p<0.05).
Conclusions: Mobilisation status on the day of surgery may have the greatest influence on same day discharge. We advocate for prompt physiotherapy and adequate post-operative analgesia to allow for earlier mobilisation and discharge home. We will perform further prospective data collection to increase cohort numbers.
