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Patient selection criteria for outpatient joint arthroplasty

Abstract

Purpose

General consensus of patient selection criteria for outpatient joint arthroplasty is lacking, which is paramount to prevent prolonged hospital stay, adverse events and/or readmissions. This review highlights patient selection criteria for OJA based on the current literature and expert opinion.

Methods

A search of the English and International electronic healthcare databases including MEDLINE/PubMed, EMBASE, AMED and the Cochrane library was performed in November 2015 to include studies published during the last 10 years. Furthermore, a survey of physicians from different specialties was performed.

Results

Fourteen studies described results regarding outpatient joint arthroplasty. Studies on outpatient hip and/or knee arthroplasty resulted in similar outcome in preselected patients. Patients who are able and willing to participate, with a low ASA classification (<III), undergoing primary arthroplasty, age <75 and with support at home during the first postoperative days are eligible candidates for outpatient joint arthroplasty. Patients with a high ASA classification (>II), bleeding disorders, poorly controlled and/or severe cardiac (e.g. heart failure, arrhythmia) or pulmonary (e.g. embolism, respiratory failure) comorbidities, uncontrolled DM (type I or II), a high BMI (>30 m2/kg), chronic opioid consumption, functional neurological impairments, dependent functional status, chronic/end-stage renal disease and/or reduced preoperative cognitive capacity should be excluded from outpatient joint arthroplasty. The expert opinion-based selection criteria were comparable to literature with a further extension of exclusion for patients with practical issue’s, urologic medical history and/or severe mobility disorders.

Conclusion

Based on the current literature, the presented patient selection criteria provide a basis for outpatient joint arthroplasty and can be useful when selecting patients. Together with a change in mindset, a multidisciplinary approach and literature-based protocols, outpatient joint arthroplasty can be applied in daily orthopaedic practice while ensuring patients’ safety.

Level of evidence

Clinical review, Level III.

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Acknowledgments

The authors would like to express their gratitude to all the involved physicians from the different departments in our hospital, which collaborated on this paper. We also thank Dr. A. F. Chen from the Rothman Institute, Philadelphia, USA, who served as external reader, and for her comments that greatly improved the manuscript.

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Correspondence to Nanne P. Kort.

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Conflict of interest

One of the authors (NK) is a paid consultant for Zimmer-Biomet. The other authors declare that they have no conflict of interest. No financial support was received for this study.

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Kort, N.P., Bemelmans, Y.F.L., van der Kuy, P.H.M. et al. Patient selection criteria for outpatient joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 2668–2675 (2017). https://doi.org/10.1007/s00167-016-4140-z

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Keywords

  • Outpatient surgery
  • Hip arthroplasty
  • Knee arthroplasty
  • Patient selection criteria