ICJR ABSTRACTS: Preoperative Oral Hydration Is Safe in Rapid Recovery THA

    At the 7th Annual ICJR South Hip & Knee Course, 6 awards were given to orthopaedic residents and fellows who submitted the best research abstracts in hip and knee replacement. The abstract Preoperative Oral Hydration Is Safe in Rapid Recovery THA received the Game-Changer Award: Hip Arthroplasty and was presented at the meeting by Andrew D. Posner, MD, on behalf of lead author Afshin A. Anoushiravani, MD.

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    Afshin A. Anoushiravani, MD; James E. Feng, MD; Andrew D. Posner, MD; Kimberly Jean-Louis, RN; Ran Schwarzkopf, MD, MSc; and Roy I. Davidovitch, MD


    Fluid and food restrictions prior to surgery are thought to reduce the risk for perioperative aspiration pneumonia. However, the recent anesthesia literature suggests that clear fluids up to 2 hours before surgery may be tolerated. Here we investigate the safety and efficacy of a standardized hydration protocol among same-day discharge (SDD) THA candidates.


    All patients scheduled to undergo primary same-day discharge (SDD) THA between January 2017 and April 2018 were included. Surgical candidates between September 2017 and April 2018 participated in the hydration initiative, which allowed for the consumption of 32 oz of clear fluid 2 hours prior to surgery. Surgical recipients between January and August 2017 were used as historical controls. Baseline demographics and quality metrics were prospectively collected and analyzed to define the impact of a hydration protocol in SDD-THA.


    In total, 585 consecutive SDD-THA candidates were included in this study, of which 309and 276 patients were in the control and hydration cohorts, respectively. Hydration protocol participants were significantly older (57.35 vs 60.27 years; p<.001) and more likely to have Medicare (14.61% vs 31.75%; p<.001). Univariable analysis of postoperative outcomes demonstrated that a similar number of THA recipients failed SDD (7.44% vs 7.97%; p=0.88). Multivariable regression demonstrated similar outcomes after controlling for all collected patient risk factors (OR 0.95; 95% CI 0.48-1.88; p=.89).


    Our study suggests hydration protocols are safe and non-inferior to standard NPO restrictions. Future studies are needed to better elucidate the role of perioperative hydration before THA.

    Click the image above to watch Dr. Posner’s presentation of this Game-Changer Award-winning abstract.

    Author Information

    Afshin A. Anoushiravani, MD , and Andrew D. Posner, MD, are from the Department of Orthopaedic Surgery at Albany Medical Center, Albany, New York.

    James E. Feng, MD; Kimberly Jean-Louis, RN; Ran Schwarzkopf, MD, MSc; and Roy I. Davidovitch, MD, are from NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York.