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With the introduction of fast-track pathways and the positive results regarding patient safety and efficacy, orthopaedic surgeons are becoming more convinced of the revolutionary changes towards outpatient surgery pathways. Beside the patient-related factors (e.g. adequate pain protocol, PONV prevention, early discharge, early mobilisation, prevention of blood loss) and operative related factors (e.g. Patient Specific Instruments, Local Infiltration Analgesia, ceasing tourniquet, low-dose spinal anaesthesia), the complete arthroplasty process in itself is equally important (e.g. logistic factors, planned discharge, health economic issues). The first results of outpatient surgery for knee arthroplasty are promising and, more orthopaedic departments are performing outpatient surgery for their arthroplasty procedures. A change in the pre-, peri- and postoperative procedures is a complicated and complex process, in which a multi-disciplinary team is essential. Ongoing monitoring of the results is paramount to keep moving forward in optimising the pathway. All the stakeholders involved need to be convinced of these ‘new’ optimisations and should control the protocols, which eventually will lead to a change in the patients’ mindset, and early discharge can be possible. On the other hand, since outpatient surgery procedures are on the rise worldwide, the literature on these pathways is limited. The key question that leads to optimal safety and efficacy is: which patients are eligible for inclusion in the outpatient surgery pathway? Future research should focus on this question, not only the technical aspects of the knee and hip arthroplasty operation or optimisation of the current pathway protocols (pre-, peri- and postoperative), which are of major importance, needs to be examined but the complete package is the key factor towards successful outpatient joint arthroplasty. A proactive attitude in the multi-disciplinary approach for the Outpatient Joint Arthroplasty is required with use of evidence-based protocols.
Outpatient Arthroplasty requires teamwork (according to established protocols) between the patient and his immediate surroundings, primary care and medical specialists at the hospital.
Direct lines of communication between all team members are essential; a proactive approach is the factor of success.
Transatlantic Current Concepts in Outpatient Arthroplasty will equip the Orthopedic Surgeons and collaborating providers, institutions, manufacturers, payers, and patients with an in-depth protocol to implement or optimize the Outpatient Arthroplasty.
That way we can ensure the safety and quality for patients in Outpatient Arthroplasty.