Bypass PACU in Knee and Hip Arthroplasty

Study Overview
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Brief Summary
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A Quality Study in the use of Post-Anaesthesia Care Unit(PACU) in Hip and Knee Arthroplasty, and the ability to bypass this unit. The investigators wish to investigate the amount of patients who is required to be secondary admitted to the PACU, after primary discharge from the operating room to the surgical ward, thereby bypassing the PACU.

Detailed Description
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The investigators wish to investigate the use of our standardized regimen for discharging patients directly to the surgical ward, thereby bypassing the PACU. The anaesthesiology dept. have a local standard operating procedure for doing this, and the patients will be treated according to this. This means that Patients will be discharged directly to the surgical ward if the following criteria are met: American Society of Anaesthesiologist-score (ASA-score) < 3 Anaesthesia and surgery without any complications, vital signs normal during the whole procedure and not demanding oxygen supplement on the end of the procedure. Bloodloss < 500 ml. Postoperative evaluation, Early Warning Score, and postoperative score documented in Electronic Patient journal(EPJ). The patients will upon arrival at the surgery start a registration containing preoperative data(baseline morbidity, sex, height, weight, type of anaesthesia and surgery), perioperative data containing surgery and anaesthesia data, and postoperative discharge-score(local operating procedure). After discharge to either the surgical ward or the PACU, the patient will be observed closely the first 2 hours while recording every intervention made by the nurse staff. After the initial 2 hours the recording goes on the next 24 hours recording every event and intervention which lead to a doctor consult, by telephone or physically examining the patient. Also, the investigators wish to evaluate the use of the discharge Score(Danish Society of Anaesthesia and Intensive care Medicine(DASAIM)-SCORE), which is used as the discharge score after surgery in other hospitals in Denmark, and the investigators therefore record this after surgery, and every 30 minutes after the surgery for the first 2 hours.

Official Title
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Bypass Post-Anesthesia Care Unit(PACU) in Knee and Hip Arthroplasty - A Quality Cohort Study

Conditions
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Surgery, Knee Osteoarthritis, Postoperative Complications, Hip Osteoarthritis, Arthroplasty Complications

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Planned elective unilateral primary Hip- og Knee-Arthroplasty and unicompartmental Knee-Arthroplasty. Above 18 years. Exclusion Criteria: none

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 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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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Bypassing PACU | Number of patients in need of secondary relocation to the Post Anaesthesia Care unit after knee and hip arthroplasty. | Within the first 24 hours. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative actions and interventions by nurses within 2 hours. | Postoperative interventions carried out within the first 2 hours after surgery. These interventions will be recorded in a preformed chart. The recording will take place booth in the PACU and in the surgical ward, to thereby make a comparison of the two. | 2 hours after surgery. | 
| Postoperative actions and interventions within 24 hours. | Postoperative interventions and deviant events/complications that require a contact to a medical doctor, either by telephone or personal oversight, carried out within the first 24 hours after surgery. These interventions will be recorded in a preformed chart. This registration will take place where the patient is hospitalized at the current timeframe. | 24 hours after surgery. | 
| 30 day Follow-up. | 30 day follow-up after surgery, concerning readmission within 8 days after surgery, length of stay and mortality. | 30 days | 
| 90 day Follow-up. | 90 day follow-up after surgery concerning readmission and mortality. | 90 days | 
| Complications after surgery. | Complications after surgery, divided in medical and surgical complications with details of type of event and time of occurence as well as treatment. | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Knee Arthroplasty, Hip Arthroplasty, Postoperative Anaesthesia Care Unit