Comparison of Outpatient versus Inpatient Total Knee Arthroplasty

Abstract

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Definitional Differences of ‘Outpatient’ Versus ‘Inpatient’ THA and TKA Can Affect Study Outcomes

“…The recent changes in healthcare insurance and the aging US population make the appropriate exploration of outpatient procedures in terms of safety and cost-effectiveness more important than ever. The large number of recent orthopaedic studies comparing inpatient and outpatient procedures underscores this importance [2,5,9,10,15,16,24,25,29,30,37,40,48].…”

“…The benefits of outpatient arthroplasty are reported to include higher patient satisfaction and reduced costs [15,29]. Multiple studies comparing the outcomes of inpatient with outpatient arthroplasty have been reported [2,5,9,10,15,16,24,25,29,30,37,40,48]. However, the difference between ''inpatient'' and ''outpatient'' is not as intuitive as one might think.…”

“…This ''observation'' status obscures the division between what is considered inpatient or outpatient. Some studies on outpatient arthroplasty have defined ''outpatient'' status as patients who were discharged the same day [5,9,10], patients who stayed at most one night at the hospital [2,4,24], patients who stayed at most two nights at the hospital [15,25], or simply provided stated status with no quantitative description [16,29,40].…”

Toward Outpatient Arthroplasty

“…19,20 Compared with hip arthroplasty, there is more data available with regard to the feasibility of performing total knee arthroplasty as an outpatient or 23-hour procedure. 7,17,[21][22][23][24][25] One randomized, doublemasked, placebo-controlled study showed that patients receiving 4 days of ambulatory femoral CPNB (n = 25) attained 3 critical discharge criteria (adequate analgesia, independence from intravenous analgesics, and independent ambulation >30 meters) in a median of 25 hours, compared with 71 hours for those receiving only an overnight ropivacaine infusion (n = 25, P<0.001). 25 A multicenter study using a nearly identical protocol reported that the extended ambulatory femoral infusion resulted in patients attaining the 3 discharge criteria in a median of 47 hours, compared with 62 hours for those of the control group (estimated ratio = 0.80, 95% CI: 0.66-1.00; P = 0.028).…”

Improved Health-Related Quality of Life after Knee Arthroplasty Following an Outpatient Surgery Pathway: an Observational Comparative Case Study

“…Such optimization is also known as 'outpatient joint arthroplasty' , a multimodal clinical pathway based on well-defined patient selection criteria [1][2][3] with the focus on discharge on the day of surgery while ensuring patients' safety [1,[4][5][6][7][8] and cost reduction [9,10,11]. Results have shown that quality of life after TKA, significantly improved within one year postoperative [11].…”