Length of Stay, Same-day Discharge
Conditions
Keywords
Carbohydrate Drink, Perioperative Fluids, Same-day Discharge, Total Joint Arthroplasty, Nausea, Vomiting, Same-day total hip arthroplasty, Same-day total knee arthroplasty
Brief summary
The purpose of this study is to investigate if the consumption of a complex carbohydrate drink preoperatively, decreases the length of stay and causes for failure to launch in patients undergoing ambulatory total joint arthroplasty.
Detailed description
The way total joint arthroplasty is practiced continues to evolve as CMS removed total hip arthroplasty (THA) from the inpatient-only list and added total knee arthroplasty (TKA) to the ASC Covered Surgical Procedures List (CPL) in 2020. Thus, surgeons must find subtle interventions that improve patient outcomes while minimizing the risk of adverse reactions. Current literature has not assessed the influence of preoperative hydration, using a complex carbohydrate drink, on the same-day discharge rate and causes for failure to launch. Considering variabilities in perioperative fluid management leading to postoperative nausea, vomiting, and dizziness, the investigators seek to reduce the incidence of these events by optimizing patients using a preoperative oral hydration protocol, reducing the length of stay, and improving same-day discharge rates.
Interventions
DIETARY_SUPPLEMENTComplex Carbohydrate Drink
Patients will drink a complex carbohydrate drink 3 hours before surgery. Drink to be given at the preoperative holding area.
Sponsors
Hospital for Special Surgery, New York
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
* Candidates for ambulatory total knee arthroplasty * Candidates for ambulatory total hip arthroplasty * Candidates for ambulatory revision knee arthroplasty (liner exchange only) * Candidates for ambulatory revision hip arthroplasty (liner exchange only) * Case scheduled before noon (12 pm) * Patient agrees to same-day discharge and has a responsible adult to spend the night on the day of discharge
Exclusion criteria
* BMI less than 18.5 or greater than 37.0 * Patients with diabetes, chronic kidney disease, clotting disorders, or neurological conditions preventing control of the affected limb. * Pregnant women * Patients scheduled as ambulatory due to insurance mandates * Patients with a history of active ischemia, significant valvular disease, significant arrhythmias, obstructive sleep apnea as per Hospital for Special Surgery guidelines, chronic opioid dependence (chronic daily opioid use for six or more months), and glomerular filtration rate \< 60ml/min.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Length of hospital stay in hours | From admission to discharge, up to 1 week | Length of hospital stay in hours, assess by medical record. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Same day discharge rate | Through study completion, an average of 3 months. | Percentage of patients discharged successfully the day of surgery. |
| Number of physical therapy sessions attempted | From admission to discharge, up to 1 week. | Number of physical therapy sessions attempted, assess by medical record. |
| Total distance walked | From admission to discharge, up to 1 week. | Total distance walked during physical therapy attempts, assess by medical record. |
| Number of stairs climbed | From admission to discharge, up to 1 week. | Number of stairs climbed during physical therapy attempts, assess by medical record. |
| Orthostatic hypotension episodes | During physical therapy attempts, from admission to discharge. | Orthostatic hypotension episodes during physical therapy attempts, assess by medical record. |
| HOOS JR Score | The morning of surgery and at the first post-operative visit, up to 4 months post-op. | This is a 6-item questionnaire that assesses patient-reported hip pain and function. Score ranges from 0-100, with 100 representing the best possible score. |
| KOOS JR Score | The morning of surgery and at the first post-operative visit, up to 4 months post-op. | This is a 6-item questionnaire that assesses patient reported knee pain and function. Score ranges from -100, with 100 representing the best score possible. |
| VR-12 Score | The morning of surgery and at the first post-operative visit, up to 4 months post-op. | The VR-12 is a 12-item self-reported questionnaire that assesses the patient physical and mental quality of life. |
| Urine osmolality | Measured preoperatively the morning of surgery. | Urine osmolality taken preoperatively, assess by medical record. |
| Urine specific gravity | Measured preoperatively the morning of surgery. | Urine specific gravity preoperatively, assess by medical record. |
| In-house costs | From admission to discharge, up to 1 week. | In-house costs taking into account cost of complex carbohydrate drink vs previously published costs savings per night of stay. |
Countries
United States
Contacts
CONTACTJose Rodriguez, MD
CONTACTRicardo Torres-Ramirez, BS
PRINCIPAL_INVESTIGATORJose A Rodriguez, MD
Hospital for Special Surgery, New York
Outcome results
None listed