Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care

Inpatient versus Outpatient Total Knee Arthroplasty

“…23 While database studies have shown conflicting results, other studies have shown similar risk of adverse events and readmissions when patient selection is narrowed to include only younger and healthier patients. 14,20,[25][26][27] Although these studies reported a similar risk of adverse events and complications, it is important to note the strict selection criteria used by in these studies. To select a healthy cohort of patients, patients with a history of diabetes mellitus, myocardial infarction, stroke, congestive heart failure, deep venous thromboembolism, pulmonary embolism, cardiac arrhythmia, respiratory failure, chronic pain requiring regular opioid medications, active cardiopulmonary disease, history of sleep apnea, active anticoagulation therapy, and significant obesity were all excluded.…”

“…To select a healthy cohort of patients, patients with a history of diabetes mellitus, myocardial infarction, stroke, congestive heart failure, deep venous thromboembolism, pulmonary embolism, cardiac arrhythmia, respiratory failure, chronic pain requiring regular opioid medications, active cardiopulmonary disease, history of sleep apnea, active anticoagulation therapy, and significant obesity were all excluded. 18,20,27 Many patients do not meet these stricter criteria for OP TKA.…”

“…31 While no significant differences in patient satisfaction have been reported, the observed trends tended to favor OP surgeries. 27,32 Another recent study revealed patients prefer to recover at home, even when they expect a need for more hospital days. 33 It comes as no surprise that patients undergoing same day discharge have reported excellent patient satisfaction when participating in a comprehensive OP total joint program that utilizes careful patient selection, refined surgical techniques, modern anesthesia protocols (including selective nerve blocks), and multimodal pain management regimens that limit the reliance on narcotic medications.…”

Patient Perceptions Regarding Outpatient Hip and Knee Arthroplasties

“…[1,5,8,11] Rapid recovery protocols have created a natural evolution from the inpatient to the outpatient setting. [2,3,6,10,[12][13][14] Outpatient total joint arthroplasty (TJA) has been successfully performed during the past decade [4,13,[15][16][17][18][19][20], albeit for the most part by highly experienced surgeons with carefully selected patients. Success has been attributed to multidisciplinary care coordination, standardized perioperative protocols, discharge planning, and careful patient selection.…”

Day-case surgery for total hip and knee replacement

“…While most day-case TJA publications used minimally invasive muscle-sparing approaches, 3 , 16 , 18 , 20 , 22 , 25 , 26 successful day-case TJA may also be achieveable with conventional approaches. 9 - 11 Alternative minimally invasive muscle-sparing approaches for TKA and THA have been shown to speed up recovery time and would probably help with successful day-case TJA. 3 , 16 , 25 , 26 …”