Total Ankle Arthoplasty as a Day Case Surgery: How Safe and Effective it is?

Abstract

Category: Ankle Arthritis Introduction/Purpose: Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. Total ankle arthroplasty (TAA) is a surgical procedure commonly used for patients with painful arthritis. As the number of TAA procedures increase, so does the associated economic burden. The purpose of this study was to evaluate patients undergoing total ankle arthroplasty, who were discharged on the same day as undergoing surgery. These patients have stayed in the hospital for <12 hours, and are referred to as ‘‘outpatients.’’ Outpatients were evaluated with regard to the following outcomes: (1) postoperative pain; (2) perioperative complications and healthcare provider visits (readmission). We also assessed patients’ satisfaction regarding discharge on the same day as surgery. Methods: The medical records of 46 consecutive TAA outpatients from July 2018 to June 2019 with a minimum 1 month post- operative follow-up, were reviewed. All patients received an Integra Cadence TAA. Prior to surgery, all patients received popliteal blocks. Patients were discharged home with a popliteal catheter, which they were to remove themselves after 48 hours. After removal of the catheter, patients were prescribed oral pain medication to help with any pain or discomfort. The following data was collected: demographics, comorbidities, (ASA) class, and perioperative complications, including wound breakdown, infection, revision and non-revision surgeries. At their 1-month post-operative visit, patients completed a questionnaire regarding their satisfaction post-surgery, which consisted of six questions. Results: There were no readmissions for pain control, no signs of wound infection among the 46 outpatients. All patients were ‘very satisfied’ with the surgical procedure and with recommend methods of pain control. The majority of patients were also very satisfied with discharge on the same day as surgery with the exception of patients who would have liked to stay overnight. When asked if they would recommend the care they experienced to a friend with the same condition, 46 patients said that they would definitely recommend this process to a friend. In terms of rating their pain on a scale of 0-10 (0 being no pain, 10 being worst pain imaginable), the average score for the 46 patients was 2.03. Conclusion: Our study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory outpatient experience and no readmissions for pain control.