General Anaesthesia Versus Spinal Anaesthesia for Outpatient Total Hip and Knee Arthroplasty: A Randomised Trial Protocol.

Introduction

Background and Rationale

Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common and effective treatments for osteoarthritis and other degenerative or inflammatory joint diseases, leading to decreased pain, enhanced quality of life and reduced mortality [1,2,3]. Outpatient arthroplasty pathways can reduce costs and may reduce healthcare‐associated infection risk, with comparable patient satisfaction and, in selected patients, low complication rates [4,5,6]. Same‐day arthroplasty pathways are designed in accordance with Enhanced Recovery After Surgery (ERAS) principles, encompassing preoperative optimisation, opioid‐sparing multimodal analgesia, standardised antiemetic prophylaxis and early mobilisation [7]. However, unsuccessful same‐day discharge and unplanned readmissions remain important safety and implementation challenges [8].

Both spinal anaesthesia (SA) and general anaesthesia (GA) are routinely used for THA/TKA [9]. International consensus statements and observational comparative‐effectiveness research suggest neuraxial techniques may be associated with fewer complications and a higher likelihood of earlier discharge [10,11,12]. Conversely, fast‐track pathways using short‐acting total intravenous GA (TIVA) may facilitate earlier mobilisation and shorter length of stay in some contexts [13,14]. Existing evidence in the outpatient setting is mixed and is largely observational, with potential confounding by patient selection (e.g., higher American Society of Anesthesiologists (ASA) classification among patients receiving GA in routine care) [15,16].

There is a clear evidence gap regarding the comparative effectiveness of GA versus SA in outpatient primary THA/TKA when the primary goal is successful same‐day discharge and when recovery is assessed using validated patient‐reported recovery instruments.

Objectives

Exploratory Secondary Objectives

An observational cohort of screened patients ineligible for randomisation will be enrolled to allow descriptive analyses and exploratory comparisons with the randomised population.

Methods and Analysis

Protocol Reporting

This protocol is reported in accordance with the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidance. A detailed Statistical Analysis Plan (SAP) and Health Economic Analysis Plan (HEAP) will be finalised and made available prior to database lock.

Roles and Responsibilities

The sponsor of the trial is Region Örebro County. The sponsor is responsible for the overall study design, regulatory approvals, trial conduct, data management and reporting.

The principal investigators are responsible for the day‐to‐day conduct of the trial, including participant recruitment, data collection and adherence to the protocol at participating sites.

Trial oversight will be ensured through risk‐based monitoring performed by an independent monitor in accordance with Good Clinical Practice (GCP). No independent data monitoring committee is considered necessary since interventions are standard of care.

Study Design

GASPS is a pragmatic, multicentre, parallel‐group superiority randomised controlled trial with 1:1 allocation to GA or SA. Randomisation will be stratified by site and type of surgery (THA vs. TKA) using permuted blocks. An observational cohort will enrol screened patients who are eligible for outpatient surgery but are not randomised because they decline one of the anaesthetic methods or are deemed unsuitable for either technique; analyses of the observational cohort will be descriptive and exploratory.

Study Setting

Participants will be recruited from specialised orthopaedic surgical units in Sweden with established outpatient THA and/or TKA pathways.

Eligibility Criteria

Inclusion and exclusion criteria are summarised in Table1.

Table: Key eligibility criteria.

Recruitment and Consent

Potentially eligible patients will be identified through routine outpatient arthroplasty scheduling. Written study information will be sent to potentially eligible patients by post ahead of the preoperative anaesthesia assessment, at which the trial will be discussed in person. Participants will provide written informed consent prior to randomisation.

Randomisation and Allocation Concealment

Participants will be randomised 1:1 to GA or SA on the day of surgery via a secure electronic case report form system. Randomisation will use stratified permuted blocks with stratification by site and procedure (THA/TKA) to balance allocation over time. Allocation will be concealed until assignment. Participants will not be informed of allocation until first contact with anaesthesia staff on the day of surgery to reduce expectation effects.

Blinding

Blinding of anaesthesia clinicians and participants is not feasible. Most outcomes are objective time‐based measures (e.g., discharge milestones), recorded in routine care or patient‐reported, minimising but not removing the risk of bias. Data analysis will be performed blinded to treatment assignment until primary analyses are finalised.

Interventions

General Anaesthesia Group

GA will be delivered as TIVA with propofol and remifentanil using target‐controlled infusion or rate‐controlled infusion according to local routine. Airway management will use a supraglottic airway device or endotracheal intubation according to clinical judgement and local practice.

Spinal Anaesthesia Group

SA will be delivered with intrathecal bupivacaine 0.5% (1.0–2.0 mL) and may be combined with intrathecal opioid (up to fentanyl 50 μg or sufentanil 10 μg) according to local routine. Light propofol sedation is permitted at the discretion of the anaesthesiologist. The dose range reflects current Swedish practice and accounts for patient characteristics (height, weight, age) and anticipated surgical duration [18,19].

Co‐Interventions and Perioperative Care

Perioperative surgical techniques and perioperative care follow established ERAS principles for THA/TKA [7]. The standardised pathway across all sites includes: preoperative patient education, opioid‐sparing multimodal analgesia (paracetamol, NSAID when appropriate, and dexamethasone), standardised PONV prophylaxis, tranexamic acid, antibiotic prophylaxis and protocolised early mobilisation on the day of surgery. Site‐level variation in specific agents or doses is permitted within this framework, consistent with the pragmatic design. Conversions between anaesthetic techniques (e.g., failed spinal requiring GA) will be permitted as clinically necessary and documented.

Outcomes

Primary Outcome

Successful same‐day discharge, defined as discharge from hospital on the day of surgery AND no readmission within 48 h after discharge.

Key and Exploratory Secondary Outcomes

The key secondary outcomes are (1) time from start of surgery to when the patient fulfils indicators of hospital discharge (criteria specified in Table3), (2) Quality of Recovery (QoR) trajectories, (3) patients' qualitative descriptions of anaesthesia and postoperative recovery, (4) cost per gained quality‐adjusted life‐year (QALY) and (5) safety (adverse events). All other outcomes listed in Table2are exploratory, and no multiplicity correction is applied to them. Health economic data will be gathered to capture costs and QALY over a full year to account for seasonal variation, allow short‐term postoperative differences to resolve [20], and support annualised cost‐effectiveness estimates.

Table: PACU discharge criteria and indicators of possible discharge from hospital.

Table: Key and exploratory secondary outcomes.

Key and exploratory secondary outcomes are listed in Table2.

Schedule of Assessments

See Table4.

Table: Summary of the main data collection time points and instruments.

Sample Size

The trial will enrol 600 participants (300 per group). This sample size provides 80% power at a two‐sided 5% significance level to detect an absolute difference of 10 percentage points in successful same‐day discharge between groups, with expected success rates of 70% (GA) and 80% (SA). To account for potential loss to follow‐up, the sample size allows for approximately 1% attrition (n= 6 participants). The effect size was informed by prior literature, retrospective cohort data and clinical consensus [21].

Data Collection and Management

Trial data will be captured in an electronic case report form. Data quality will be supported by built‐in checks, monitoring and source data verification according to risk‐based monitoring principles. Data will be pseudonymised using a trial‐specific code; the re‐identification key will be stored locally at each site. All data handling will comply with the General Data Protection Regulation (GDPR) and applicable Swedish data protection legislation.

Statistical Analysis

Analyses will follow the intention‐to‐treat principle. The primary analysis of the primary outcome will compare the proportion of successful same‐day discharge between groups using a chi‐square test (or Fisher's exact test if appropriate). A prespecified adjusted analysis using logistic regression including treatment group, type of surgery and study site as fixed effects will also be performed, consistent with the stratified randomisation; both analyses will be reported. Effect estimates will be reported as risk difference and odds ratio with 95% confidence intervals. Analyses adjusted for other prespecified baseline variables will be performed as appropriate. The full analytical approach is prespecified in the statistical analysis plan, which will be finalised prior to database lock.

Continuous secondary outcomes will be analysed using independentt‐tests or non‐parametric alternatives as appropriate, and regression models for adjusted analyses. Repeated‐measures outcomes (e.g., QoR‐15 trajectories) will be analysed using mixed‐effects models including treatment group, time and group‐by‐time interaction, with participant‐level random effects and, where appropriate, site‐level effects. Binary safety endpoints will be analysed using chi‐square/Fisher's exact tests and logistic regression. Time‐to‐event endpoints may be analysed using Kaplan–Meier methods and Cox models where appropriate. A two‐sided significance level of 0.05 will be employed.

An interim analysis of the primary outcome is planned after approximately 300 participants have completed primary endpoint assessment to allow early stopping for both futility and safety. A group sequential design with O'Brien‐Fleming boundaries will be used to preserve the overall two‐sided type I error at 0.05. Exact stopping boundaries will be based on the observed information fraction at the interim analysis.

Embedded Qualitative Study

A purposive sample of approximately 20–30 trial participants (aiming for at least 10 from each group) will be invited to take part in semi‐structured interviews 14–60 days after surgery. Interviews will explore experiences of anaesthesia, outpatient discharge and postoperative recovery. Interviews will be audio‐recorded, transcribed verbatim and analysed using reflexive thematic analysis with iterative coding and theme development [22,23].

Health Economic Evaluation

A cost‐utility analysis will be performed with effects measured as quality‐adjusted life years (QALYs) derived from EQ‐5D‐5L using Swedish preference weights. Incremental cost‐effectiveness ratios will compare GA versus SA. Costs will include intervention‐related resource use, healthcare utilisation, prescribed medications and productivity losses. Analyses will be conducted from both healthcare and societal perspectives. Deterministic and probabilistic sensitivity analyses will explore uncertainty. Secondary cost‐effectiveness analyses will use successful same‐day discharge and HOOS/KOOS as effect measures.

Patient and Public Involvement

Patients and/or the public were not involved in the design of this protocol. Plans for patient‐facing dissemination include a lay summary reported in CTIS and accessible summaries of findings after trial completion.

Ethics and Dissemination

Ethics Approval and Consent

The study has received regulatory approval from the Swedish Medical Products Agency (EU CT number: 2024‐520127‐89‐00) following a favourable opinion from the Swedish Ethical Review Authority. The trial complies with Regulation (EU) No. 536/2014.

Informed consent will be obtained by a physician at each participating site. Potential participants will receive both oral and written information about the study during the preoperative anaesthesia assessment or at a dedicated study visit prior to surgery.

Participants will be given time to consider participation and to ask questions before providing written informed consent. Consent will be obtained prior to any study‐specific procedures, including randomisation. Consent includes permission to collect and use study data from medical records and patient‐reported outcomes. No biological samples will be collected for research purposes.

Participants will be informed that participation is voluntary and that they may withdraw from the study at any time without any consequences for their clinical care. Participants may also be asked to provide additional consent for participation in the embedded qualitative study involving semi‐structured interviews.

Safety Considerations

Both GA and SA are established standard‐of‐care anaesthetic techniques for THA/TKA. Eligibility criteria select patients suitable for outpatient pathways to minimise risk. Adverse events (AEs) and serious adverse events (SAEs) will be defined and assessed according to standard clinical trial definitions and recorded systematically from anaesthesia start to postoperative Day 3. Predefined adverse outcomes will be captured during follow‐up windows defined in the trial protocol.

Confidentiality

Personal data will be processed in accordance with GDPR and Swedish data protection laws. Published results will be reported in aggregate, and no individual participant will be identifiable.

Dissemination

Findings will be disseminated through peer‐reviewed journals, presentations at national and international meetings and reporting of summary results in CTIS, including a lay summary. Secondary publications are planned for recovery trajectories, qualitative findings, health economic results and longer‐term outcomes.

Data Sharing

Individual participant data will not be publicly available due to privacy and regulatory restrictions. De‐identified data may be made available upon reasonable request to the corresponding author, subject to approval by the sponsor and relevant authorities, and in accordance with applicable data protection regulations.

The SAP and HEAP will be finalised and made publicly available in an open‐access repository prior to database lock and analysis. The statistical code used for the primary analyses will be made available following publication of the results.

Trial Status

At the time of submission, the trial status is: not yet recruiting.

Two sites, Lindesberg Hospital and Hässleholm Hospital, are participating in the study from the start. Additional sites may be added. Protocol versions are as stated on the title page. Recruitment start and end dates will be reported in upcoming reports.

Discussion

The choice of anaesthetic methods in TKA and THA has changed little over the last decades despite reduced hospitalisation. Observational studies and register‐based analyses have suggested advantages for neuraxial anaesthesia in terms of perioperative complications and length of stay [12,24], yet recent cohort data from ambulatory settings show comparable outcomes regardless of technique [9,25], and two small randomised trials have even indicated faster recovery with TIVA [13,14].

GASPS is designed as a pragmatic trial; this means that the study is conducted as close to routine clinical care as possible at centres with established outpatient arthroplasty programmes. This design philosophy has several advantages as it enhances external validity, facilitates recruitment, and ensures that the findings are applicable to implementation. Stratification by site and procedure (THA/TKA) in the randomisation further reduces the risk that site‐level variation in co‐interventions confounds the primary comparison, and sensitivity analyses adjusting for important co‐interventions will be pre‐specified in the SAP.

However, some standardisations are required to maintain features that define modern GA and SA in this context while allowing for variation in elements that do not alter the nature of the techniques [26].

Inclusion and exclusion criteria for this study focus on including all patients that may participate in the study but exclude for safety, unsuitability for either SA or GA, or factors that make successful same day discharge unlikely. Unicompartmental knee arthroplasty is not included in the trial, as it differs from TKA in surgical invasiveness and recovery profile. Preoperative opioid use is one such factor that has been described to increase the risk of unsuccessful same day discharge in the literature, and most Swedish outpatient pathways exclude all patients with higher doses of preoperative opioids [21].

Choice of Primary Endpoint

We chose successful same‐day discharge as the primary outcome because it reflects the goal of outpatient arthroplasty pathways and is meaningful to patients, clinicians and healthcare systems. Unlike surrogate measures such as time to first mobilisation or pain scores at a single time point, same‐day discharge integrates multiple domains of recovery—pain control, haemodynamic and respiratory stability, motor function, absence of surgical complications and patient willingness—into a single, pragmatic endpoint. A composite definition requiring no readmission within 48 h was added to guard against premature discharge that merely shifts morbidity to a later time point [4,16,27]. The limitations of this endpoint include reasons for not being discharged that are not entitled to medical and patient‐related causes and that there is some subjectivity included in the discharge decision.

Quality of Recovery‐15 as a Key Secondary Outcome

QoR‐15 was selected as the principal patient‐reported recovery outcome because it captures a multidimensional construct—physical comfort, emotional state, pain, physical independence and patient support—that is not adequately reflected by single‐item measures such as pain scores alone [28]. QoR‐15 has been validated in multiple languages and surgical populations including outpatient orthopaedic surgery, and has an established minimal clinically important difference [29,30,31,32].

In GASPS, QoR‐15 is administered daily from postoperative Day 1–14 and weekly until Day 35. This extended assessment is a strength of the trial, as most studies have measured QoR‐15 only at 24 h or at hospital discharge [31], similar findings were also identified when reviewing assessment of recovery in research [33]. In both studies, the researchers suggest that recovery should be measured several times during recovery [31,33]. Patients are willing to report daily on how they experience their recovery, and digital assessment has a higher response rate compared to paper‐based assessment [34,35]. The repeated‐measures design will enable characterisation of the recovery trajectory and identification of the time point at which any potential between‐group difference appears or resolves. This trajectory‐based analysis addresses the need to move beyond single‐snapshot recovery assessments and to examine quality of care beyond traditional markers of morbidity and/or mortality [17,36]. To mitigate this, the digital follow‐up platform sends reminders to support frequent QoR‐15 completion. Repeated‐measures outcomes will be analysed using mixed models, which provide valid estimates under the assumption that data are Missing At Random (MAR). Should the proportion of missing data exceed a threshold specified in the SAP, sensitivity analysis using multiple imputation will be performed.

Assumed Treatment Effect and Sample Size

The sample size is based on an absolute difference of 10 percentage points in successful same‐day discharge (70% vs. 80%). This estimate was informed by published discharge rates from outpatient arthroplasty cohorts and retrospective comparisons of anaesthetic technique, but same‐day discharge rates vary widely [4,9,16,21].

A 10‐percentage‐point difference was both in line with earlier studies and deemed clinically meaningful in consultation between orthopaedic surgeons and anaesthesiologists at participating centres. Smaller differences, whereas potentially statistically detectable with a larger sample, are unlikely to change clinical practice on their own.

Blinding

Full blinding of participants is not feasible given the nature of the interventions, and this represents an acknowledged limitation of the trial. Since the majority of outcomes are either recorded as part of routine care or are patient‐reported, the associated risk of bias is considered small. Blinding of statistical analyses will be maintained as a mitigation strategy. We consider transparent acknowledgement of this limitation preferable to artificially constraining patient–provider interactions.

Qualitative Study

The embedded qualitative study is designed to contextualise the quantitative findings by exploring patients' experiences of anaesthesia, discharge process and early recovery. Although the quantitative methods can establish whether the interventions work, qualitative methods are needed to add deeper understanding of how and why outcomes differ, to capture aspects of the patient experience that questionnaires may overlook, and to provide ideas for further studies [37].

Previous qualitative studies in the fast‐track arthroplasty context have shown that patients' experiences of early discharge are shaped by factors such as preparedness, sense of safety, pain management and social support—themes that are difficult to capture with purely quantitative instruments [34,38,39]. The purposive sampling strategy targeting 20–30 participants (at least 10 per group) is guided by the principle of information power [40]. Reflexive thematic analysis was chosen for its flexibility and theoretical accessibility [22,23]. One limitation will be the inherited risk of selection of patients willing to participate in this part of the study.

Conclusions

This study is designed to determine the most effective anaesthetic method for same‐day discharge after primary THA and TKA including embedded health economic and qualitative analyses of patient experiences. In the era of increasing outpatient surgeries, this study will be helpful for anaesthesia providers and outpatient centres for optimisation of their processes.

Author Contributions

Erik Noppa:conceptualisation, methodology, writing – original draft, writing – review and editing, project administration.Karuna Dahlberg:conceptualisation, methodology, writing – review and editing.Alex de Leon:conceptualisation, methodology, writing – review and editing.Maziar Mohaddes:methodology, writing – review and editing.Anna Philipson:methodology, writing – review and editing.Peter Wildeman:conceptualisation, writing – review and editing.Kristofer F. Nilsson:conceptualisation, methodology, supervision, funding acquisition, writing – review and editing. All authors read and approved the final version of the manuscript.

Funding

This work was supported by ALF funding Region Örebro County grant number OLL‐1010516 and OLL‐993657.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Associated Data

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

References

1. Cross W. W., Saleh K. J., Wilt T. J., and Kane R. L., “Agreement About Indications for Total Knee Arthroplasty,” Clinical Orthopaedics and Related Research 446 (2006): 34–39. doi.org/10.1097/01.blo.0000214436.49527.5e
2. Ethgen O., Bruyère O., Richy F., Dardennes C., and Reginster J.‐Y., “Health‐Related Quality of Life in Total Hip and Total Knee Arthroplasty: A Qualitative and Systematic Review of the Literature,” Journal of Bone and Joint Surgery 86 (2004): 963–974. doi.org/10.2106/00004623-200405000-00012
3. Lie S. A., Engesaeter L. B., Havelin L. I., Gjessing H. K., and Vollset S. E., “Mortality After Total Hip Replacement: 0‐10‐Year Follow‐Up of 39,543 Patients in the Norwegian Arthroplasty Register,” Acta Orthopaedica Scandinavica 71 (2000): 19–27. doi.org/10.1080/00016470052943838
4. Gromov K., Jørgensen C. C., Petersen P. B., et al., “Complications and Readmissions Following Outpatient Total Hip and Knee Arthroplasty: A Prospective 2‐Center Study With Matched Controls,” Acta Orthopaedica 90 (2019): 281–285. doi.org/10.1080/17453674.2019.1577049
5. Jaibaji M., Volpin A., Haddad F. S., and Konan S., “Is Outpatient Arthroplasty Safe? A Systematic Review,” Journal of Arthroplasty 35 (2020): 1941–1949. doi.org/10.1016/j.arth.2020.02.022
6. Kelly M. P., Calkins T. E., Culvern C., Kogan M., and Della Valle C. J., “Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction?,” Journal of Arthroplasty 33 (2018): 3402–3406. doi.org/10.1016/j.arth.2018.07.025
7. Wainwright T. W., Gill M., McDonald D. A., et al., “Consensus Statement for Perioperative Care in Total Hip Replacement and Total Knee Replacement Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations,” Acta Orthopaedica 91 (2020): 3–19. doi.org/10.1080/17453674.2019.1683790
8. Migliorini F., Pintore A., Cipollaro L., Oliva F., and Maffulli N., “Outpatient Total Knee Arthroplasty: A Meta‐Analysis,” Applied Sciences 11 (2021): 9376.
9. Yap E., Wei J., Webb C., Ng K., and Behrends M., “Neuraxial and General Anesthesia for Outpatient Total Joint Arthroplasty Result in Similarly Low Rates of Major Perioperative Complications: A Multicentered Cohort Study,” Regional Anesthesia and Pain Medicine 47 (2022): 294–300. doi.org/10.1136/rapm-2021-103189
10. Duque M., Schnetz M. P., Yates A. J., et al., “Impact of Neuraxial Versus General Anesthesia on Discharge Destination in Patients Undergoing Primary Total Hip and Total Knee Replacement,” Anesthesia and Analgesia 133 (2021): 1379–1386. doi.org/10.1213/ANE.0000000000005156
11. Johnson R. L., Kopp S. L., Burkle C. M., et al., “Neuraxial vs General Anaesthesia for Total Hip and Total Knee Arthroplasty: A Systematic Review of Comparative‐Effectiveness Research,” British Journal of Anaesthesia 116 (2016): 163–176. doi.org/10.1093/bja/aev455
12. Memtsoudis S. G., Sun X., Chiu Y. L., et al., “Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients,” Anesthesiology 118 (2013): 1046–1058. doi.org/10.1097/ALN.0b013e318286061d
13. Harsten A., Kehlet H., and Toksvig‐Larsen S., “Recovery After Total Intravenous General Anaesthesia or Spinal Anaesthesia for Total Knee Arthroplasty: A Randomized Trial,” British Journal of Anaesthesia 111 (2013): 391–399. doi.org/10.1093/bja/aet104
14. Harsten A., Kehlet H., Ljung P., and Toksvig‐Larsen S., “Total Intravenous General Anaesthesia vs. Spinal Anaesthesia for Total Hip Arthroplasty: A Randomised, Controlled Trial: Spinal or General Anesthesia for Hip Arthroplasty,” Acta Anaesthesiologica Scandinavica 59 (2015): 298–309. doi.org/10.1111/aas.12456
15. Gazendam A. M., Tushinski D., Patel M., et al., “Causes and Predictors of Failed Same‐Day Home Discharge Following Primary Hip and Knee Total Joint Arthroplasty: A Canadian Perspective,” Hip International 33 (2023): 576–582, 10.1177/11207000221111101. doi.org/10.1177/11207000221111101
16. Keulen M. H. F., Asselberghs S., Boonen B., Hendrickx R. P. M., Van Haaren E. H., and Schotanus M. G. M., “Predictors of (Un)successful Same‐Day Discharge in Selected Patients Following Outpatient Hip and Knee Arthroplasty,” Journal of Arthroplasty 35 (2020): 1986–1992. doi.org/10.1016/j.arth.2020.03.034
17. Nilsson U., Gruen R., and Myles P. S., “Postoperative Recovery: The Importance of the Team,” Anaesthesia 75 (2020): e158–e164. doi.org/10.1111/anae.14869
18. Van Egmond J. C., Verburg H., Derks E. A., et al., “Optimal Dose of Intrathecal Isobaric Bupivacaine in Total Knee Arthroplasty,” Canadian Journal of Anesthesia/Journal Canadien D'anesthésie 65 (2018): 1004–1011. doi.org/10.1007/s12630-018-1165-4
19. Lemoine A., Mazoit J. X., and Bonnet F., “Modelling of the Optimal Bupivacaine Dose for Spinal Anaesthesia in Ambulatory Surgery Based on Data From Systematic Review,” European Journal of Anaesthesiology 33 (2016): 846–852. doi.org/10.1097/EJA.0000000000000528
20. Stigmar K., Dahlberg L. E., Zhou C., Jacobson Lidgren H., Petersson I. F., and Englund M., “Sick Leave in Sweden Before and After Total Joint Replacement in Hip and Knee Osteoarthritis Patients,” Acta Orthopaedica 88 (2017): 152–157. doi.org/10.1080/17453674.2016.1269051
21. Gong M. F., McElroy M. J., Li W. T., et al., “Reasons and Risk Factors for Failed Same‐Day Discharge After Total Joint Arthroplasty,” Journal of Arthroplasty 39 (2024): 1468–1473. doi.org/10.1016/j.arth.2023.11.032
22. Braun V. and Clarke V., “Using Thematic Analysis in Psychology,” Qualitative Research in Psychology 3 (2006): 77–101.
23. Braun V. and Clarke V., “What Can “Thematic Analysis” Offer Health and Wellbeing Researchers?,” International Journal of Qualitative Studies on Health and Well‐Being 9 (2014): 26152. doi.org/10.3402/qhw.v9.26152
24. Memtsoudis S. G., Cozowicz C., Bekeris J., et al., “Anaesthetic Care of Patients Undergoing Primary Hip and Knee Arthroplasty: Consensus Recommendations From the International Consensus on Anaesthesia‐Related Outcomes After Surgery Group (ICAROS) Based on a Systematic Review and Meta‐Analysis,” British Journal of Anaesthesia 123 (2019): 269–287. doi.org/10.1016/j.bja.2019.05.042
25. Calkins T. E., Johnson E. P., Eason R. R., Mihalko W. M., and Ford M. C., “Spinal Versus General Anesthesia for Outpatient Total Hip and Knee Arthroplasty in the Ambulatory Surgery Center: A Matched‐Cohort Study,” Journal of Arthroplasty 39 (2024): 1463–1467. doi.org/10.1016/j.arth.2023.12.020
26. Loudon K., Treweek S., Sullivan F., Donnan P., Thorpe K. E., and Zwarenstein M., “The PRECIS‐2 Tool: Designing Trials That Are Fit for Purpose,” BMJ 350 (2015): h2147. doi.org/10.1136/bmj.h2147
27. Debbi E. M., Mosich G. M., Bendich I., Kapadia M., Ast M. P., and Westrich G. H., “Same‐Day Discharge Total Hip and Knee Arthroplasty: Trends, Complications, and Readmission Rates,” Journal of Arthroplasty 37 (2022): 444–448.e1. doi.org/10.1016/j.arth.2021.11.023
28. Stark P. A., Myles P. S., and Burke J. A., “Development and Psychometric Evaluation of a Postoperative Quality of Recovery Score,” Anesthesiology 118 (2013): 1332–1340. doi.org/10.1097/ALN.0b013e318289b84b
29. Myles P. S., Myles D. B., Galagher W., Chew C., MacDonald N., and Dennis A., “Minimal Clinically Important Difference for Three Quality of Recovery Scales,” Anesthesiology 125 (2016): 39–45. doi.org/10.1097/ALN.0000000000001158
30. Kleif J., Waage J., Christensen K. B., and Gögenur I., “Systematic Review of the QoR‐15 Score, a Patient‐ Reported Outcome Measure Measuring Quality of Recovery After Surgery and Anaesthesia,” British Journal of Anaesthesia 120 (2018): 28–36. doi.org/10.1016/j.bja.2017.11.013
31. Myles P. S., Shulman M. A., Reilly J., Kasza J., and Romero L., “Measurement of Quality of Recovery After Surgery Using the 15‐Item Quality of Recovery Scale: A Systematic Review and Meta‐Analysis,” British Journal of Anaesthesia 128 (2022): 1029–1039. doi.org/10.1016/j.bja.2022.03.009
32. Lyckner S., Böregård I.‐L., Zetterlund E.‐L., and Chew M. S., “Validation of the Swedish Version of Quality of Recovery Score −15: A Multicentre, Cohort Study,” Acta Anaesthesiologica Scandinavica 62 (2018): 893–902. doi.org/10.1111/aas.13086
33. Jaensson M., Nilsson U., and Dahlberg K., “Methods and Timing in the Assessment of Postoperative Recovery: A Scoping Review,” British Journal of Anaesthesia 129 (2022): 92–103. doi.org/10.1016/j.bja.2022.04.015
34. Dahlberg K., Jaensson M., Nilsson U., Eriksson M., and Odencrants S., “Holding It Together—Patients' Perspectives on Postoperative Recovery When Using an e‐Assessed Follow‐Up: Qualitative Study,” JMIR mHealth and uHealth 6 (2018): e10387. doi.org/10.2196/10387
35. Descamps J., Le Hanneur M., Bouché P.‐A., Boukebous B., Duranthon L.‐D., and Grimberg J., “Do Web‐Based Follow‐Up Surveys Have a Better Response Rate Than Traditional Paper‐Based Questionnaires Following Outpatient Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial,” Orthopaedics and Traumatology, Surgery and Research 109 (2023): 103479. doi.org/10.1016/j.otsr.2022.103479
36. Myles P., “Measuring Quality of Recovery in Perioperative Clinical Trials,” Current Opinion in Anaesthesiology 31 (2018): 396–401, 10.1097/aco.0000000000000612. doi.org/10.1097/aco.0000000000000612
37. Nilsson U., Jaensson M., Dahlberg K., and Hugelius K., “Postoperative Recovery After General and Regional Anesthesia in Patients Undergoing Day Surgery: A Mixed Methods Study,” Journal of Perianesthesia Nursing 34 (2019): 517–528, 10.1016/J.JOPAN.2018.08.003. doi.org/10.1016/J.JOPAN.2018.08.003
38. Jansson M. M., Harjumaa M., Puhto A., and Pikkarainen M., “Patients' Satisfaction and Experiences During Elective Primary Fast‐Track Total Hip and Knee Arthroplasty Journey: A Qualitative Study,” Journal of Clinical Nursing 29 (2020): 567–582. doi.org/10.1111/jocn.15121
39. Specht K., Agerskov H., Kjaersgaard‐Andersen P., Jester R., and Pedersen B. D., “Patients' Experiences During the First 12 Weeks After Discharge in Fast‐Track Hip and Knee Arthroplasty – A Qualitative Study,” International Journal of Orthopaedic and Trauma Nursing 31 (2018): 13–19. doi.org/10.1016/j.ijotn.2018.08.002
40. Malterud K., Siersma V. D., and Guassora A. D., “Sample Size in Qualitative Interview Studies: Guided by Information Power,” Qualitative Health Research 26 (2016): 1753–1760. doi.org/10.1177/1049732315617444

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Republished from the open web under CC-BY. Authors: Noppa E, Dahlberg K, de Leon A, Mohaddes M, Philipson A, Wildeman P, Nilsson KF. Read the original.