• Hillenn Cruz Eng, Sheila Riazi, Christian Veillette, Noam Ami, Ahtsham U Niazi, Ki Jinn Chin, Vincent W S Chan, and Anahi Perlas.
• From the Departments of Anesthesia and Pain Management (H.C.E., S.R., N.A., A.U.N., K.J.C., V.W.S.C., A.P.), and Surgery (C.V.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
• Anesthesiology. 2015 Dec 1;123(6):1256-66.

BackgroundCommon standard practice after complex arthroscopic elbow surgery includes hospital admission for 72 h. The authors hypothesized that an expedited care pathway, with 24 h of hospital admission and ambulatory brachial plexus analgesia and continuous passive motion at home, results in equivalent elbow range of motion (ROM) 2 weeks after surgery compared with standard 72-h hospital admission.MethodsA randomized, single-blinded study was conducted after obtaining approval from the research ethics board. Forty patients were randomized in a 1:1 ratio using a computer-generated list of random numbers into an expedited care pathway group (24-h admission) and a control group (72-h admission). They were treated equally aside from the predetermined hospital length of stay.ResultsPatients in the control (n = 19) and expedited care pathway (n = 19) groups achieved similar elbow ROM 2 weeks (119 ± 18 degrees and 121 ± 15 degrees, P = 0.627) and 3 months (130 ± 18 vs. 130 ± 11 degrees, P = 0.897) postoperatively. The mean difference in elbow ROM at 2 weeks was 2.6 degrees (95% CI, -8.3 to 13.5). There were no differences in analgesic outcomes, physical function scores, and patient satisfaction up to 3 months postoperatively. Total hospital cost of care was 15% lower in the expedited care pathway group.ConclusionThe results suggest that an expedited care pathway with early hospital discharge followed by ambulatory brachial plexus analgesia and continuous passive motion at home is a cost-effective alternative to 72 h of hospital admission after complex arthroscopic elbow surgery.

64 keywords...

hide…