Impact of Outpatient Total Joint Replacement on Postoperative Outcomes

Lovett-Carter, Danielle; Sayeed, Zain; Abaab, Leila; Pallekonda, Vinay; Mihalko, William M.; Saleh, Khaled J.

doi:10.1016/j.ocl.2017.08.006

Cited by 24 publications

(21 citation statements)

References 24 publications

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“…TKA can be effectively and safely performed in a subset of patients in the ambulatory setting or with hospital-based SDD [8][9][10]31]. A variety of approaches to identifying predictors of SDD following TKA have been described [18,32,33].…”

Section: Discussionmentioning

confidence: 99%

“…To facilitate a safe transition to ambulatory TKA, arthroplasty surgeons can build upon their experience with same-day discharges (SDDs) of TKA patients in the hospital setting to identify the best candidates for ASC-based TKA. Evidence from prior studies shows that younger patients with a lower body mass index (BMI) and fewer comorbidities are more appropriate candidates for SDD or ASC-based TKA [9,10]. Besides careful patient selection, standardized perioperative protocols, multidisciplinary care coordination, and discharge planning are other important aspects of successful SDD [5,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

et al. 2021

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Background: In January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA. Methods: A retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 oneday length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conducted. Multiple logistic regression was used to evaluate predictors of SDD, as these patients represent those most likely to safely undergo TKA in an ASC. Results: Controlling for other demographics and comorbidities, patients with the following characteristics were at reduced odds of SDD: increased age (odds ratio [OR] ¼ 0.935, P < .001), body mass index !35 (OR ¼ 0.491, P ¼ .002), female (OR ¼ 0.535, P < .001), nonwhite race (OR ¼ 0.456, P ¼ .003), primary hypertension (OR ¼ 0.710, P ¼ .032), !3 comorbidities (OR ¼ 0.507, P ¼ .002), American Society of Anesthesiologists score !3 (OR ¼ 0.378, P < .001). The model was deemed to be of adequate fit using the Hosmer and Lemeshow test (c 2 ¼ 12.437, P ¼ .112), and the area under the curve was found to be 0.773 indicating acceptable discrimination. Conclusion: For patients undergoing primary TKA, increased age, body mass index !35, female gender, nonwhite race, primary hypertension, !3 comorbidities, and American Society of Anesthesiologists score !3 decrease the likelihood of SDD. A predictive model based on readily available patient presentation and comorbidity characteristics may aid surgeons in identifying patients that are candidates for SDD or ASC-based TKA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

et al. 2021

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“…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.…”

Section: Risks Of Outpatient Tkamentioning

confidence: 96%

“…23,24 Many surgeons would acknowledge that a significant number of patients are not candidates for OP TKA, so the development of consistent selection criteria is critical as pressures increase to eliminate a hospital stay after TKA. 14,20,25,26,28…”

Section: Outcomes Of Outpatient Tkamentioning

confidence: 99%

Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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The rise of improved perioperative recovery protocols after total knee arthroplasty (TKA) has led to faster, more streamlined hospital stays for many patients. Combined with the implementation of value-based care and bundled payment initiatives, there has been a paradigm shift toward outpatient TKA surgery. This change to practice has been accelerated by recent policy changes enacted by the Center for Medicaid and Medicare Services regarding the removal of TKA as an inpatient only procedure as well as some insurance companies denying preauthorization for inpatient stays after TKA. Our review aims to address the inclusion and exclusion criteria for outpatient TKA consideration, examine the outcomes for outpatient joint replacement surgery, and discuss limitations of widespread adoption for same-day discharges.

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“…Length of stay has decreased for primary and revision arthroplasty procedures alike since the early days of joint replacement. As both surgeons and patients gain experience and comfort with the concept of outpatient total hip arthroplasty (THA), and with an increasing number of studies documenting its safety and favourable outcomes, 1–27 the question arises if perhaps the outpatient setting may be feasible for some conversion and revision THA scenarios in selected patients.…”

Section: Introductionmentioning

confidence: 99%

The feasibility of outpatient conversion and revision hip arthroplasty in selected patients

et al. 2019

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Background: Total hip arthroplasty (THA) continues moving to the outpatient arena, and may be feasible for some conversion and revision scenarios. Controversy surrounds appropriate patient selection. The purpose of this study is to report complications associated with outpatient revision and conversion THA, and to determine if comorbidities are associated with complications or overnight stay. Methods: From June 2013 through August 2018, 46 patients (47 hips) underwent conversion ( n = 10) or revision ( n = 37) THA at a free-standing ambulatory surgery centre. This represented only 6.3% of revision THA cases at our institution during the study period that were selected for outpatient surgery. Mean patient age was 58.0 years, and 52% of patients were males. 1 or more major comorbidities were present in 15 patients (32%) including 1 valvular disease, 7 arrhythmia, 2 thromboembolism history, 3 obstructive sleep apnoea, 3 chronic obstructive pulmonary disease, 2 asthma, 4 frequent urination, and 1 renal disease. Results: 44 (94%) patients were discharged same day without incident, none required transfer to acute facility, and 3 stayed overnight (2 convenience, 1 for medical reasons - urinary retention). The patient kept overnight for medical reasons had no major comorbidities. 3 patients were placed on an extended course of antibiotics, including 2 with positive intraoperative cultures and 1 for cellulitis. There were no major complications, readmissions, or subsequent surgeries within 90 days. Conclusions: Outpatient revision hip arthroplasty is safe in selected patients undergoing minor or partial revisions. Presence of medical comorbidities was not associated with risk of complications. Medical optimisation and a multimodal programme to mitigate risk of blood loss and reduce narcotic need facilitate the safe performance of arthroplasty in an outpatient setting.

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Impact of Outpatient Total Joint Replacement on Postoperative Outcomes

Cited by 24 publications

References 24 publications

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

Inpatient versus Outpatient Total Knee Arthroplasty

The feasibility of outpatient conversion and revision hip arthroplasty in selected patients

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