title: Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients.
abstract: Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consecutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices. Thirty-eight patients required some additional intervention outside the pathway to resolve nausea, hypotension, or sedation prior to discharge. There were no readmissions for pain, nausea, or hypotension yet there was one readmission for fracture and nine emergency room evaluations in the three month perioperative period. This anesthetic and rehabilitation protocol allowed outpatient total hip arthroplasty to be routinely performed in these consecutive patients undergoing primary total hip arthroplasty. With current reimbursement approaches the modest savings to the hospital in length of stay may be outweighed by the additional costs of personnel, thereby making this outpatient system more expensive to implement.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612, USA. r.a.berger@sbcglobal.net
authors.forename: Richard A
authors.initials: RA
authors.lastname: Berger
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Sanders
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Thill
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sporer
authors.forename: Craig
authors.initials: C
authors.lastname: Della Valle
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D000758:Anesthesia / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D018579:Patient Selection; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome