2023 FSA Podium and Poster Abstracts

P002: CURRENT TRENDS AND FUTURE DIRECTIONS FOR OUTPATIENT TOTAL JOINT ARTHROPLASTY: A REVIEW OF THE ANESTHESIA CHOICES AND ANALGESIC OPTIONS
Yosira Guevara, MD; Tuan G Tieu, MD; Brian M Osman, MD; University of Miami

Introduction/Background: The aging population and the obesity epidemic have led to an increased rate of joint replacement procedures, specifically total knee arthroplasty (TKA) and total hip arthroplasty (THA). These surgeries are associated with increased hospital length of stay (LOS) and, consequently, higher costs. Although a total joint arthroplasty (TJA) as an outpatient procedure can significantly reduce costs, only a few percent of TJA surgeries are performed in this manner.

Methods: We completed a broad PubMed search of current literature on the anesthesia choices and analgesic options used for outpatient total joint arthroplasty and selected publications that met the following inclusion criteria: 1) articles published in the English language between January 2017 and June 2022, 2) clinical data, 3) clinical trials, 4) systematic reviews and meta-analyses, 5) review articles, and 6) case reports.

Results: Risk stratification tools such as the Outpatient Arthroplasty Risk Assessment (OARA) help predict outcomes regarding outpatient TJA, and neuraxial anesthesia should be considered to minimize complications and facilitate early discharge. The choice of sedation to supplement spinal anesthesia depends on patient factors and should be determined on a case-by-case basis. A multimodal analgesia regimen could be effective for pain management in outpatient TJA, and the most recommended peripheral nerve blocks for THA and TKA are the fascia iliaca compartment block (FIB) and the adductor canal block, respectively. However, FIB should be carefully considered for outpatient procedures. Enhanced recovery after surgery (ERAS) protocols help to guide perioperative care teams and allow for improved patient recovery, decreased length of stay, and increased patient satisfaction.

Conclusion: The number of TJA surgeries is expected to increase substantially in the upcoming decades, especially with an aging population presenting an increased need for TKA and THA. While there continue to be significant improvements in surgical and anesthetic techniques, the concept of outpatient (same-day discharge or 23-hour observation) TJA is relatively new. Proper patient selection, patient optimization and preparation for surgery, perioperative staff coordination, implementation of ERAS protocols, rapid-recovery anesthetic techniques, blood loss mitigation, and multimodal (opioid-sparing) analgesia techniques all contribute to faster recovery after surgery, earlier ambulation and participation in physical therapy, decreased length of stay, and better patient satisfaction. The evidence in current literature supports the idea that these techniques can assist in successfully setting up and safely performing TJA surgeries in an outpatient setting.