Speakers - 2026

Title: Modifiable barriers to same-day hip and knee arthroplasty: an audit at Queen’s Hospital, Burton

Abstract

Background. Same-day discharge after hip and knee arthroplasty is increasingly achievable through enhanced recovery, optimised anaesthesia, early mobilisation and coordinated discharge planning. We audited elective arthroplasty practice at Queen's Hospital Burton to benchmark local performance and identify modifiable barriers to same-day discharge.

Methods. A combined prospective questionnaire and retrospective case-note audit was undertaken for 209 consecutive elective arthroplasty patients: 102 total hip replacements, 84 total knee replacements and 23 unicompartmental knee replacements. Data were extracted from electronic patient records, operative logs, anaesthetic charts and perioperative questionnaires. Variables included ASA grade, procedure type, anaesthetic technique, theatre timings, recovery metrics, postoperative complications, mobilisation, physiotherapy timing, discharge outcome and length of stay. National length-of-stay benchmarks were drawn from the NHS Model Health System. Chi-square and Spearman correlation analyses were performed using Microsoft Excel.

Results. Same-day discharge was achieved in 10 patients (4.8%). Mean length of stay for total hip and total knee replacement was 2.6 and 2.8 days, respectively, approximating the national mean of 2.7 days but remaining above the top-decile benchmark of 1.4-1.6 days. Unicompartmental knee replacement was significantly associated with same-day discharge (chi-square p = 0.0015), while increasing age correlated with longer length of stay (rho = 0.30, p < 0.00001). The clearest modifiable barrier was delayed mobilisation: 63% of patients waited more than four hours for first physiotherapy assessment, and time to mobilisation correlated with length of stay (rho = 0.44, p < 0.001). Among patients staying beyond 24 hours, 75% remained for ongoing physiotherapy or occupational therapy input. Postoperative urinary retention requiring catheterisation occurred in 21% of patients, with cases clustering more frequently in the 0.5% heavy bupivacaine group than the 0.25% bupivacaine group.

Conclusion. Same-day arthroplasty discharge at Queen's Hospital, Burton remains limited despite length-of-stay performance approximating national averages. The main barriers are delayed mobilisation, therapy availability and ward-level discharge workflow. A pathway focused on two-hour physiotherapy review, structured same-day mobilisation, anaesthetic refinement and explicit preoperative discharge expectations may improve performance toward top-decile benchmarks.

What will the audience take away from presentation?

• Recognise where the day-case pathway fails. The audit shows that same-day discharge was limited mainly by delayed mobilisation, therapy availability and ward-level discharge workflow rather than theatre throughput.
• Use procedure type and age to refine patient selection. UKR patients were more likely to achieve same-day discharge, while increasing age correlated with longer length of stay, supporting focused pre-assessment and discharge planning.
• Implement a measurable early-mobilisation target. With 63% of patients waiting more than four hours for first physiotherapy review, a two-hour first-physiotherapy target offers a practical pathway intervention.
• Review anaesthetic protocols for discharge-blocking complications. Postoperative urinary retention requiring catheterisation occurred in 21% of patients and clustered more frequently with 0.5% heavy bupivacaine, warranting prospective evaluation of spinal-agent selection.
• Replicate a portable audit framework. A short perioperative questionnaire combined with retrospective case-note review can help units benchmark performance, support therapy-capacity business cases and generate trainee-led quality improvement projects.