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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Complex Carbohydrate Drink Group | Experimental | 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. |
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| No-Complex Carbohydrate Drink Group | No Intervention | 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. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Complex Carbohydrate Drink | Dietary Supplement | Patients will drink a complex carbohydrate drink 3 hours before surgery. Drink to be given at the preoperative holding area. |
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| Measure | Description | Time Frame |
|---|---|---|
| Length of hospital stay in hours | Length of hospital stay in hours, assess by medical record. | From admission to discharge, up to 1 week |
| Measure | Description | Time Frame |
|---|---|---|
| Same day discharge rate | Percentage of patients discharged successfully the day of surgery. | Through study completion, an average of 3 months. |
| Number of physical therapy sessions attempted | Number of physical therapy sessions attempted, assess by medical record. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jose Rodriguez, MD | Contact | 212-552-5829 | rodriguezjose@hss.edu | |
| Ricardo Torres-Ramirez, BS | Contact | 212-260-3763 | torresr@hss.edu |
| Name | Affiliation | Role |
|---|---|---|
| Jose A Rodriguez, MD | Hospital for Special Surgery, New York | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital for Special Surgery | Recruiting | New York | New York | 10021 | United States |
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| ID | Term |
|---|---|
| D009325 | Nausea |
| D014839 | Vomiting |
| ID | Term |
|---|---|
| D012817 | Signs and Symptoms, Digestive |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| From admission to discharge, up to 1 week. |
| Total distance walked | Total distance walked during physical therapy attempts, assess by medical record. | From admission to discharge, up to 1 week. |
| Number of stairs climbed | Number of stairs climbed during physical therapy attempts, assess by medical record. | From admission to discharge, up to 1 week. |
| Orthostatic hypotension episodes | Orthostatic hypotension episodes during physical therapy attempts, assess by medical record. | During physical therapy attempts, from admission to discharge. |
| HOOS JR Score | This is a 6-item questionnaire that assesses patient-reported hip pain and function. Score ranges from 0-100, with 100 representing the best possible score. | The morning of surgery and at the first post-operative visit, up to 4 months post-op. |
| KOOS JR Score | This is a 6-item questionnaire that assesses patient reported knee pain and function. Score ranges from -100, with 100 representing the best score possible. | The morning of surgery and at the first post-operative visit, up to 4 months post-op. |
| VR-12 Score | The VR-12 is a 12-item self-reported questionnaire that assesses the patient physical and mental quality of life. | The morning of surgery and at the first post-operative visit, up to 4 months post-op. |
| Urine osmolality | Urine osmolality taken preoperatively, assess by medical record. | Measured preoperatively the morning of surgery. |
| Urine specific gravity | Urine specific gravity preoperatively, assess by medical record. | Measured preoperatively the morning of surgery. |
| In-house costs | In-house costs taking into account cost of complex carbohydrate drink vs previously published costs savings per night of stay. | From admission to discharge, up to 1 week. |