140 Variation in Day-Case Elective Surgery for Hip and Knee Replacements: A National Cross-Sectional Survey

Abstract Aim The escalating backlog of elective orthopaedic procedures, exacerbated by the pandemic and an ageing population, has spurred interest in day-case surgery as a potentially faster and safer alternative. Day-case surgery is typically defined as surgery that allows discharge on the same calendar day. A standardised guideline is currently unavailable and hospitals operate independently. This cross-sectional study aims to showcase the national variation in day-case total hip arthroplasty (THA) and total knee arthroplasty (TKA) protocols. Methods Between January and July of 2024, a cross-sectional survey was circulated to NHS Elective orthopaedic providers. Several domains in the questionnaire focused on high volume and low complexity hubs, arthroplasty nurses, criteria for day-case arthroplasty patient selection, anaesthesia, peri-articular injections and physiotherapy. Results Of 24 respondents, 83.3% had day-case pathways for hip or knee replacements. Of this, 15.0% defined 'day-case' as discharge within 24 hours. Day-case procedures averaged 15.5% (±15.9%) of total arthroplasties, ranging from <1% to 60%. “Home Living situation” was the most common variable that influenced patient suitability for the day-case pathway. The most common peri-articular injections were tranexamic acid, adrenaline, and levobupivacaine with 62.5% (n = 16) using tranexamic acid in their protocol. 47% (n = 17) of physiotherapists saw patients both pre- and post-operatively on the operative day. Conclusion Hospital protocols for day-case lower limb arthroplasty vary widely. Further studies are required to assess the effects of this variation on hospital and patient-based outcomes.