Patient selection criteria for outpatient joint arthroplasty.
OBJECTIVE
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.


CONCLUSIONS
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.


METHODS
Clinical review, Level III.
Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H v.d. Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands. n.kort@nannekort.eu.
Nanne P
NP
Kort
Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H v.d. Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands.
Yoeri F L
YFL
Bemelmans
Department of Clinical Pharmacy and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
P Hugo M
PHM
van der Kuy
Department of Anaesthesiology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
Jacqueline
J
Jansen
Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H v.d. Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands.
Martijn G M
MGM
Schotanus
D000556:Ambulatory Surgical Procedures; D019643:Arthroplasty, Replacement / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care; D018579:Patient Selection
Hip arthroplasty; Knee arthroplasty; Outpatient surgery; Patient selection criteria