The development of a day case arthroplasty service in a district general hospital setting

S Kohli, S Baker, S Markham, O Mitchell, L McMenemy, C Senior, P Ward

Dorset County Hospital

Hospital inpatient stay following arthroplasty has reduced substantially over the past decade. This is partly due to an evolution in surgical and anaesthetic techniques. Consequently, day case arthroplasty is feasible. Literature suggests increased patient satisfaction and reduced complications with reduced hospital stay, as well as benefit to the hospital bed pressures. This study aimed to assess the day case arthroplasty service at our district general hospital.

Patients were identified during Orthopaedic outpatients and referred onto a specialist anaesthetic assessment service to confirm suitability and preoperatively prepare patients for day case arthroplasty. On the day, patients follow standardised anaesthetic and post-operative protocols.
Data was collected on type of anaesthetic, procedure, time to mobilisation and discharge, and reasons for delay in discharge.

Over 6-months, 49 cases were identified, (20 TKRs, 27 THRs, 1 reverse shoulder replacement). 82% of patients had a spinal anaesthetic with the majority receiving heavy Levobupivicaine. 58% of THRs, 20 % of TKRS, and all shoulders went home the same day. Reasons for delayed discharge included 29% not mobilised within 4-6 hours, with 56% of these due to the spinal still active and 21% due to unavailability of physiotherapists.

Although there are some challenges that need to be overcome, such as an increase in physiotherapy cover out of hours, day case arthroplasty is a feasible pathway. Patients who underwent THRs were more likely to be successful than TKRs for same day discharges. This service has the potential to aid in reducing hospital bed pressures.