Comparison of outpatient versus inpatient total hip and knee arthroplasty: A systematic review and meta-analysis of complications

Xu, Joshua; Cao, Jacob; Chaggar, Gurpreet; Negus, Jonathan

doi:10.1016/j.jor.2019.08.022

Cited by 47 publications

(34 citation statements)

References 17 publications

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“…11 Most studies comparing outpatient to inpatient programs conclude that outpatient surgeries did not increase complication or readmission rates, and, overall, were not inferior. 15 We aimed to determine if combining ERAS principles to an outpatient program could reduce adverse event rate and improve patient outcomes including postoperative pain, functional recovery and satisfaction. We found that compared to STD-inpatient practice, ERAS-outpatient program reduced complications by half while not resulting in more unplanned episodes of care.…”

Section: Discussionmentioning

confidence: 99%

Improved Clinical Outcomes of Outpatient Enhanced Recovery Hip and Knee Replacements in Comparison to Standard Inpatient Procedures: A Study of Patients Who Experienced Both

Hardy

Courgeon

Pelleï

et al. 2021

Preprint

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BACKGROUND: The benefits of combining enhanced recovery after surgery (ERAS) interventions with an outpatient program for total hip/knee arthroplasty (THA/TKA) are uncertain. The primary objective was to compare adverse event rate and secondly to compare pain management, functional recovery, PROMs and satisfaction in patients who experienced both an ERAS-outpatient protocol and standard-inpatient care.METHODS: We conducted an ambidirectional single subject cohort study on 48 consecutive patients who experienced both a standard-inpatient and an ERAS-outpatient THA/TKA (contralaterally). We compared complications according to Clavien-Dindo scale and Comprehensive Complications Index (CCI), and unplanned episodes of care. Postoperative pain assessed with a numeric rating scale, opioid consumption in morphine milligram equivalents, functional recovery, patient-reported outcome measures (WOMAC, KOOS, HOOS, Forgotten Joint Score and Patient Joint Perception) and patients’ satisfaction were also evaluated.RESULTS: Following the ERAS-outpatient surgery, complication rates were reduced by more than 50% (2.1 vs 4.4, p<0.001), CCI was significantly lower (12.3 vs 19.1, p<0.001), and similar unplanned episodes of care were observed (p>0.999). In the first 8 postoperative hours, perceived pain was similar (p>0.805) while opioid consumption was significantly reduced (9.3 vs 26.5, p<0.001). Patients walked, climbed stairs, showered, performed activities of daily living, practised sports, went back to work sooner (p<0.001), but PROMs were similar between groups at the last follow-up (p> 0.188). Patients were more satisfied of the ERAS-outpatient pathway and recommended it significantly more (p <0.002). CONCLUSION: Compared to the conventional inpatient care, our ERAS-outpatient protocol proved to be safer, enable faster functional recovery, and improve patients’ satisfaction which highlight the importance of following ERAS principles when implementing an outpatient THA/TKA program.

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Section: Discussionmentioning

confidence: 99%

Improved Clinical Outcomes of Outpatient Enhanced Recovery Hip and Knee Replacements in Comparison to Standard Inpatient Procedures: A Study of Patients Who Experienced Both

Hardy

Courgeon

Pelleï

et al. 2021

Preprint

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“…Outpatient surgery has become increasingly popular in recent years in selected patients, and all the appealing aspects of standardized outpatient arthroplasty have been reported to come with no increased risk to patients’ safety (Pollock et al 2016 , Goyal et al 2017 , Vehmeijer et al 2018 , Gromov et al 2019 , Xu et al 2019 ) and at even lower cost (Husted et al 2018 ).…”

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confidence: 99%

Are functional outcomes and early pain affected by discharge on the day of surgery following total hip and knee arthroplasty?

et al. 2020

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“…In this study, a total of 13 patients (20%) completed DOS discharge, which was slightly lower when compared with most of current studies [9][10] [13]. This may because of the criteria for discharge might be relatively conservative considering the safety of patients and inadequate experience of outpatient joint arthroplasty in our institution.…”

Section: Discussionmentioning

confidence: 60%

“…A shorter LOS could effectively save the cost of hospitalization and reduce the risk of nosocomial infection [18]. Current studies have con rmed the safety and e cacy of outpatient UKA [7][9] [13]. Meanwhile, excellent anesthesia and intraoperative monitoring were necessary for ensuring the safety and e cacy of the operation.…”

Section: Discussionmentioning

confidence: 99%

“…Whether types of anaesthesia have potential impact on perioperative outcomes of outpatient UKA remains controversial. Several studies suggested that SA reduces the rate of complications and healthcare resource utilization [13] [14]. But there were few studies speci cally examined those patients who would be eligible to be outpatient UKA candidates.…”

Section: Introductionmentioning

confidence: 99%

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Spinal Versus General Anesthesia for the Outpatient Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial

Chen¹,

Yin²,

Xu³

et al. 2020

Preprint

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Purpose: To compare the early clinical outcomes between anesthetic techniques in outpatient unicompartmental knee arthroplasty (UKA) and investigate factors responsible for delayed discharge. Method: A randomized controlled trial was conducted on 64 consecutive and unselected patients who underwent primary, medial UKA and randomly divided into two groups:32 patients with spinal anaesthesia(Group A) and 32 with general anaesthesia(Group B). There were no significant differences in gender, age, body mass index (BMI), the hospital for Special Surgery knee score (HSS), and American Society of Anesthesiology(ASA) class between the two groups (P >0.05).Results：Totally 64 patients were involved, including 20 males and 42 females, with an average age of 60.4 ± 3.8 year-old. The length of stay(LOS) and total expense were significantly less in group A than those in group B (P < 0.05). There was no significant difference between two groups on the discharge day and the reasons for not discharge(P>0.05). Lack of mobilization (84%), pain (23%), and PONV (17%) were main reasons for patients not meeting the discharge criteria on DOS (Table 2). Patients with spinal anaesthesia underwent a longer surgery time than those with GA.(P<0.05); Patients in the Group A had a significantly earlier oral fluid intake and walking unaided(P<0.05); Pain occurred significantly earlier in Group B(P<0.05). Conclusion: In patients who underwent outpatient UKA, spinal anaesthesia is significantly superior to general anaesthesia with shorter discharge time and lower cost. With strict patient selection and safe anaesthesia, outpatient UKA could attain a good clinical outcome with both anaesthesia techniques.

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Comparison of outpatient versus inpatient total hip and knee arthroplasty: A systematic review and meta-analysis of complications

Cited by 47 publications

References 17 publications

Improved Clinical Outcomes of Outpatient Enhanced Recovery Hip and Knee Replacements in Comparison to Standard Inpatient Procedures: A Study of Patients Who Experienced Both

Improved Clinical Outcomes of Outpatient Enhanced Recovery Hip and Knee Replacements in Comparison to Standard Inpatient Procedures: A Study of Patients Who Experienced Both

Are functional outcomes and early pain affected by discharge on the day of surgery following total hip and knee arthroplasty?

Spinal Versus General Anesthesia for the Outpatient Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial

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