Improving day surgery rates of anterior cruciate ligament reconstruction
surgery in surgical units not dedicated to performing day surgery
Abstract
Background and Aims Current guidance advises that at least 90% of
anterior cruciate ligament reconstructions are performed as day case
operations. Same-day surgery rates achieved by surgical units have
significant clinical and financial implications. The primary aim of this
multi-centre study was to determine the rate of admission and causes for
admissions in patients undergoing anterior cruciate ligament
reconstruction. Method Patient documentations were studied for those who
underwent an elective anterior cruciate ligament reconstruction between
January 2015 and April 2019. Contributing factors related to admission
length were investigated and included patient age, gender, body mass
index (BMI), operating surgeon, operating hospital, American Society of
Anaesthesiology (ASA) grade, and position of the patient on the
operating list. Both univariate and multivariate analysis was conducted
using the STATA/IC 16.1 statistical package. Results The day surgery
rate of anterior cruciate ligament reconstructions were 52% (50/95).
Patients positioned later on the operating list were more likely to be
admitted post-operatively (OR – 4.49; p=0.002; 95% CI – 1.72-11.69)
and this was the only factor associated with admission. A large majority
of admitted patients (95.6%) were admitted without a clinical cause and
were otherwise safe for same-day discharge. Conclusions The day surgery
rate for ACL reconstruction remains low, despite an extremely low
complication rate. Reconfiguration of the operating lists and
positioning anterior cruciate ligament reconstructions earlier in the
day will likely increase the same-day discharge rate.