Day of surgery discharge after unicompartmental knee arthroplasty: an effective perioperative pathway.

Day of surgery (DOS) discharge after unicompartmental knee arthroplasty (UKA) allows for safe, efficient care of the appropriately selected patient. Refinement of our perioperative pathway over the last decade has allowed for successful DOS discharge of 160 consecutive patients. The cohort averaged 65 years and American Society of Anesthesiology class was 1-3 (mean, 1.8). Perioperative pain control included a preoperative single shot femoral nerve block. Mean recovery room time was 121 (SD = 37) minutes. No patient required overnight admission for uncontrolled pain or nausea. Significant improvements in Knee Society Clinical Rating System (KSCRS) scores and high patient satisfaction were observed. This study details critical components of our simple perioperative pathway that can be utilized to safely perform UKA with discharge on the DOS.

Argon beam coagulation versus fibrin sealant for hemostasis following liver resection: a randomized study in a porcine model.

BACKGROUND/AIMS: Bleeding from the raw liver surface represents a significant surgical complication after elective liver resection or hepatic trauma. The application of argon beam coagulation (ABC) has been proposed to improve hemostasis, but is associated with significant necrosis of the liver parenchyma. Topical hemostatic agents, i.e. fibrin sealant (FS), have also been recommended, yet the optimal management is under debate. This study compares the efficacy and safety of both methods following liver resection in an animal model. METHODOLOGY: Twenty pigs underwent liver resection, and were then randomized into ABC or FS group for treatment of raw liver surfaces. Intraoperative and postoperative parameters were studied. Animals were sacrificed at day 12, and extent of necrosis was assessed using a scoring system and morphometry. RESULTS: Intraoperative parameters did not show any significant difference between two groups except for shorter time of application in the FS group. Postoperatively, animals in the FS group showed significantly higher hemoglobin levels (p=0.0001). Histologically, FS showed a smaller depth of necrosis than ABC (p=0.022). CONCLUSIONS: The use of FS is superior to ABC for management of the raw liver surface after liver resection, in terms of application time, postoperative bleeding and the extent of liver tissue necrosis.