PACU Discharge Without Motorfunction Assessment After Spinal Anaesthesia

Study Overview
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Brief Summary
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The study investigates the safety of discharge from the Post-Anesthesia Care Unit (PACU) without assessment of motorfunction after spinal anesthesia for total hip- or knee replacement. This is an randomized controlled trial between two groups with assessment of normal (Aldrete) PACU discharge criteria with or without assessment of the motorfunction. The study hypothesis is that it is safe to be discharged from the PACU to a ward without assessment of motor function. The main outcome is length of hospial stay (LOS) in days and re-admission within the first 30 days after surgery . Secondary outcomes include adverse events up to 24 hours after surgery, and minuttes spent in the PACU after surgery. Participants will be monitores for adverse events for the first 24 hours after surgery and reported. The total number of minuttes spent in the PACU will be recorded and reported.

Detailed Description
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A novel analysis of the latest database version was performed 06.04.2015, showing that 86.7% of patients have LOS of less than 5 days and no re-admission within the first 30 days after discharge. The study is designed as a non-inferiority study with a two-sided 5% significance level, 80% power and a non-inferiority level of 5%, resulting in 2 x 725 patients (1500 in total including drop-outs). A 30-day re-admission period was chosen to detect complications that could be assumed to have occurred as a consequence of the potential earlier PACU discharge The study will also investigate Length of stay, incidence of failed anesthesia, and reason for stay in PACU after THA and TKA 24.11.2016 A substudy based upon the un-published data from the time in PACU will be performed to analyse factors related to adverse events occuring during the PACU stay, and description of specific organdysfunction based upon the recordings from the modifed Aldrete discharge criteria. Preoperative demographic data are collected from charts and the Lundbeck Centre for Fast-track Hip and Knee Replacement database, (LCDB), intraoperative data from anesthesia charts. A logistic regression analysis will be performed with the YES/NO outcome of moderate/severe adverse PACU events at any time during PACU stay, and pre- and intr operatie variables.

Official Title
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PACU Discharge Without Motorfunction Assessment After Spinal Anaesthesia for Total Hip or Knee Arthroplasty - a Multicenter Randomized Controlled Trial

Conditions
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Osteoarthritis Susceptibility 3

Intervention / Treatment
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* Procedure: assessment of motorfunction in PACU


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age 18 yr or more primary unilateral total hip or knee arthroplasty spinal anesthesia Exclusion Criteria: intraoperative conversion to general anesthesia intraoperative bleeding exceeding 750 ml.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: no assessment of motorfunction in PACU<br>no assessment of motorfunction after spinal anesthesia in PACU | |
| Active Comparator: motorfunction assessment in PACU<br>Assesment of motorfunction after spinal anesthesia | Procedure: assessment of motorfunction in PACU<br>* assessment of motorfunction in PACU after spinal anesthesia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lenght of stay (in days) or 30 day readmissions | The main outcome is a compund measure of the duration of hospitalization after operation )measured in days, and named Length of Stay LOS) adn/or re-admission within the first 30 days after discharge. | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events | Any event that results in a physicians assessment of the patient, not including regular rounds during the first 24 hours after surgery. | 24 hours postooperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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knee, arthroplasty, spinal, anesthesia, hip