PhD defence Mark Hendrik Franciscus Keulen

Keywords: Care pathway, Hip and knee replacement, Outpatient arthroplasty, Same-day discharge

"Outpatient Hip and Knee Arthroplasty: Advancing the Optimization of Care Pathways"

This thesis investigates whether hip and knee replacements can safely be performed as outpatient procedures, allowing patients to go home on the same day of surgery. A review of international studies shows that carefully selected patients—typically younger and healthier—experience similar complication and readmission rates as those staying one or more nights, while healthcare costs can be substantially reduced. In a Dutch hospital, 79% of patients scheduled for outpatient surgery were successfully discharged. Common reasons for overnight stays included unsafe mobility due to temporary leg weakness or numbness, dizziness, wound leakage, and pain. Surveys among Dutch orthopedic surgeons revealed that only 18% currently offer outpatient hip and knee replacement, with growing interest from others; key barriers include patient selection and organizational support. Interviews with patients and caregivers showed high satisfaction, with most preferring outpatient care for faster recovery, privacy, and comfort at home. Overall, outpatient joint replacement appears safe, effective, and well-received, provided patients are carefully selected, properly supported, and adequate safety nets are in place.

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