Preoperative Oral Hydration in the Ambulatory Arthroplasty Population

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.

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.