Abstract
Fluid and food restrictions prior to surgery are thought to reduce the risk for perioperative
aspiration pneumonia. However, the recent anesthesia literature suggests that clear
fluids up to 2 hours before surgery may be tolerated. Here we investigate the safety
and efficacy of a standardized hydration protocol among same-day discharge total hip
arthroplasty (SDD-THA) candidates. All patients scheduled to undergo primary SDD THA
between January 2017 and October 2018 were included. Surgical recipients between January
2017 and August 2017 were used as historical controls. Surgical recipients between
September 2017 and October 2018 participated in the hydration initiative which allowed
for the consumption of 32 oz of clear fluid 2 hours prior to surgery. Baseline demographics
and quality metrics were prospectively collected and analyzed to define the impact
of a hydration protocol in SDD THA. In total, 585 consecutive SDD-THA candidates were
included in this study, of which 309 and 276 patients were in the control and hydration
cohorts, respectively. Univariable analysis of postoperative outcomes demonstrated
that a similar number of THA recipients failed SDD (7.44 vs. 7.97%; p = 0.88); however, a clinically meaningful reduction in hypotensive episodes was observed
among the hydration cohort (0.4 vs. 1.9%; p = 0.08). Multivariable regression demonstrated similar outcomes after controlling
for all collected patient risk factors (odds ratio 0.95; 95% confidence interval 0.48–1.88;
p = 0.89). Our study suggests hydration protocols are safe and may reduce the clinical
incidence of postoperative hypotension when compared with standard nil per os restrictions.
Future studies are needed to better elucidate the role of perioperative hydration
before THA. The level of evidence of the study is level II, prospective observational
cohort.
Keywords
same-day discharge - total hip arthroplasty - hydration - NPO - fasting - quality
metrics
