• Hong Jing Lee, Sheng Xu, Eric Xuan Liu, Jason Beng Teck Lim, LiowMing Han LincolnMHLDepartment of Orthopaedic Surgery, Singapore General Hospital, Singapore., Hee Nee Pang, Darren Keng-Jin Tay, Seng Jin Yeo, and Jerry Yongqiang Chen.
• Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
• Singapore Med J. 2024 Oct 22.

IntroductionThe current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge.MethodsAll 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively. Patient characteristics and postoperative outcomes, such as number of physiotherapy sessions required before clearance for home, time taken after surgery to ambulate >10 m and length of stay (LOS), were recorded. Patients were grouped based on surgical end time (morning/afternoon/ evening) and time of physiotherapy review (morning/afternoon/evening/morning after). Patients successfully passed ERAS day surgery protocol if they were discharged within 24 h.ResultsWith regard to the timing of operation, the morning group had the shortest LOS (P = 0.001) and a higher ERAS day surgery pass rate than the afternoon group (P = 0.016). With regard to the timing of physiotherapy, the afternoon group took the shortest time to ambulate >10 m (P < 0.001), had the shortest LOS (P < 0.001) and had a higher ERAS day surgery pass rate as compared to the morning after the operation group (P = 0.005).ConclusionPatients who ended their operations in the morning and received physiotherapy review in the same afternoon were the most likely to be discharged within 24 h due to early ambulation and adequate time for spinal anaesthesia to wear off.Copyright © 2024 Copyright: © 2024 Singapore Medical Journal.

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