Successful 24-hour discharge for total knee arthroplasty: importance of timing of surgery and physiotherapy in enhanced recovery after surgery protocol.

Hong Jing Lee, Sheng Xu, Eric Xuan Liu, Jason Beng Teck Lim, Ming Han Lincoln Liow, Hee Nee Pang, Darren Keng-Jin Tay, Seng Jin Yeo, Jerry Yongqiang Chen
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Abstract

Introduction: The current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge.

Methods: All 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively. Patient characteristics and postoperative outcomes, such as number of physiotherapy sessions required before clearance for home, time taken after surgery to ambulate >10 m and length of stay (LOS), were recorded. Patients were grouped based on surgical end time (morning/afternoon/ evening) and time of physiotherapy review (morning/afternoon/evening/morning after). Patients successfully passed ERAS day surgery protocol if they were discharged within 24 h.

Results: With regard to the timing of operation, the morning group had the shortest LOS (P = 0.001) and a higher ERAS day surgery pass rate than the afternoon group (P = 0.016). With regard to the timing of physiotherapy, the afternoon group took the shortest time to ambulate >10 m (P < 0.001), had the shortest LOS (P < 0.001) and had a higher ERAS day surgery pass rate as compared to the morning after the operation group (P = 0.005).

Conclusion: Patients who ended their operations in the morning and received physiotherapy review in the same afternoon were the most likely to be discharged within 24 h due to early ambulation and adequate time for spinal anaesthesia to wear off.

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全膝关节置换术后 24 小时成功出院:手术时机和物理治疗在术后恢复强化方案中的重要性。
导言:关于哪些患者因素(如果有的话)可预测术后恢复增强型全膝关节置换术(ERAS)24小时内的成功出院率,目前的文献说法不一。本研究旨在探讨手术和物理治疗的时机对 24 小时内成功出院率的影响:对2020年8月至2021年7月期间接受ERAS日间手术TKA的342名患者进行了前瞻性随访。记录患者特征和术后结果,如出院前所需的物理治疗次数、术后步行大于10米所需的时间和住院时间(LOS)。根据手术结束时间(上午/下午/傍晚)和物理治疗复查时间(上午/下午/傍晚/术后上午)对患者进行分组。如果患者在24小时内出院,则成功通过ERAS日间手术方案:在手术时间方面,上午组患者的 LOS 最短(P = 0.001),ERAS 日间手术通过率高于下午组(P = 0.016)。在物理治疗时间方面,与上午手术后组相比,下午手术后组患者步行>10米所需时间最短(P < 0.001),LOS时间最短(P < 0.001),ERAS日间手术通过率更高(P = 0.005):结论:上午结束手术并在当天下午接受物理治疗复查的患者最有可能在24小时内出院,因为他们可以尽早下床活动,脊髓麻醉也有足够的时间消退。
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