Preoperative Oral Hydration in the Ambulatory Arthroplasty Population

Hospital for Special Surgery (HSS)

Status: Enrolling

Conditions: Same-day Discharge; Length of Stay

Treatments: Dietary Supplement: Complex Carbohydrate Drink

Study type: Interventional

Funder types: Other

Identifiers

NCT05520593

2020-2597

Details and patient eligibility

About

The purpose of this study is to investigate if the consumption of a complex carbohydrate drink preoperatively, decreases the length of stay and causes for failure to launch in patients undergoing ambulatory total joint arthroplasty.

Full description

The way total joint arthroplasty is practiced continues to evolve as CMS removed total hip arthroplasty (THA) from the inpatient-only list and added total knee arthroplasty (TKA) to the ASC Covered Surgical Procedures List (CPL) in 2020. Thus, surgeons must find subtle interventions that improve patient outcomes while minimizing the risk of adverse reactions. Current literature has not assessed the influence of preoperative hydration, using a complex carbohydrate drink, on the same-day discharge rate and causes for failure to launch. Considering variabilities in perioperative fluid management leading to postoperative nausea, vomiting, and dizziness, the investigators seek to reduce the incidence of these events by optimizing patients using a preoperative oral hydration protocol, reducing the length of stay, and improving same-day discharge rates.

Enrollment: 312 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Candidates for ambulatory total knee arthroplasty
• Candidates for ambulatory total hip arthroplasty
• Candidates for ambulatory revision knee arthroplasty (liner exchange only)
• Candidates for ambulatory revision hip arthroplasty (liner exchange only)
• Case scheduled before noon (12 pm)
• Patient agrees to same-day discharge and has a responsible adult to spend the night on the day of discharge

Exclusion criteria

• BMI less than 18.5 or greater than 37.0
• Patients with diabetes, chronic kidney disease, clotting disorders, or neurological conditions preventing control of the affected limb.
• Pregnant women
• Patients scheduled as ambulatory due to insurance mandates
• Patients with a history of active ischemia, significant valvular disease, significant arrhythmias, obstructive sleep apnea as per Hospital for Special Surgery guidelines, chronic opioid dependence (chronic daily opioid use for six or more months), and glomerular filtration rate < 60ml/min.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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312 participants in 2 patient groups

Complex Carbohydrate Drink Group

Experimental group

Description:

The patients will drink a 400ml drink that contains 50g of complex carbohydrates, 3 hours prior to the surgery. The drink will be given once at the preoperative holding area. Patients are not allowed to eat solid foods after 12am the morning of surgery and can only drink clear fluids up to 3 hours prior to the surgery.

Treatment:

Dietary Supplement: Complex Carbohydrate Drink

No-Complex Carbohydrate Drink Group

No Intervention group

Description:

These patients will follow normal institutional preoperative fluid management guidelines, this consist of no solid foods after 12am the morning of surgery. Patients are allowed to drink clear liquids (water, clear fruit juices, coffee) from 12am the morning of surgery up to 3 hours prior to the surgery.