Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction?

Kelly, Matthew C.; Calkins, Tyler E.; Culvern, Chris; Kogan, Monica; Valle, Craig J. Della

doi:10.1016/j.arth.2018.07.025

Cited by 121 publications

(59 citation statements)

References 8 publications

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“…This is a notable result, since the broad rationale behind transition of services to the ASC is lower cost. Prior studies have found greater joint replacement patient satisfaction in ASCs [17,20] and this may be a factor in driving up demand for ASC provision of these services. This result also aligns with an earlier study which found that relative ASC to HOPD payments by commercial insurers were considerably higher among ASCs that specialized in orthopedic surgery than ASCs in other specializations [23].…”

Section: Discussionmentioning

confidence: 97%

“…Studies of total joint replacement in freestanding ASCs have begun only recently, with the generally positive result that the ASC setting is safe for select patients [15e19]. One study showed greater patient satisfaction in ASCs compared to the traditional inpatient stay [20]. Although ASCs are normally perceived as low cost settings, previous studies of total joint replacement have not conducted comparisons of hospital and ASC relative costs.…”

mentioning

confidence: 99%

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Patient Outcomes Following Total Joint Replacement Surgery: A Comparison of Hospitals and Ambulatory Surgery Centers

Carey

Morgan

Lin

et al. 2020

The Journal of Arthroplasty

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Background: For several years, many orthopedic surgeons have been performing total joint replacements in hospital outpatient departments (HOPDs) and more recently in ambulatory surgery centers (ASCs). In a recent shift, the Centers for Medicare and Medicaid Services began reimbursing for total knee replacement surgery in HOPDs. Some observers have expressed concerns over patient safety for the Medicare population particularly if Centers for Medicare and Medicaid Services extends the policy to include total hip replacement surgery and coverage in ASCs. Methods: This study used a large claims database of non-Medicare patients to examine inpatient and outpatient total knee replacement and total hip replacement surgery performed on a near-elderly population during 2014-2016. We applied propensity score methods to match inpatients with ASC patients and HOPD patients with ASC patients adjusting for risk using the HHS Hierarchical Condition Categories risk adjustment model. We conducted statistical tests comparing clinical outcomes across the 3 settings and examined relative costs. Results: Readmissions, postsurgical complications, and payments were lower for outpatients than for inpatients. Within outpatient settings, readmissions and postsurgical complications were lower in ASCs than in HOPDs but payments for ASC patients were higher than payments for HOPD patients. Conclusion: Our findings support the argument that outpatient total joint replacement is appropriate for select patients treated in both HOPDs and ASCs, although in the commercially insured population, the latter services may come at a cost. Until further study of outpatient total joint replacement in the Medicare population becomes available, how this will extrapolate to the Medicare population is unknown.

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Patient Outcomes Following Total Joint Replacement Surgery: A Comparison of Hospitals and Ambulatory Surgery Centers

Carey

Morgan

Lin

et al. 2020

The Journal of Arthroplasty

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“…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.…”

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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“…Over the past decade, there has been increasing interest in performing primary hip and knee replacement in the outpatient setting [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], and rapid recovery protocols have created a natural evolution from the inpatient to outpatient setting [2], [3], [6], [10], [21], [22], [23]. The interest in outpatient arthroplasty also has been fueled by financial considerations including the ability to control costs within the episode of care, the potential for surgeon ownership in ambulatory surgery centers, and the ability of a surgeon to control his or her operating room and surgical care environment more easily in an ambulatory surgery center [1], [5], [8], [24].…”

Section: Forewordmentioning

confidence: 99%

The American Association of Hip and Knee Surgeons, Hip Society, Knee Society, and American Academy of Orthopaedic Surgeons Position Statement on Outpatient Joint Replacement

Meneghini

Gibson

Halsey

et al. 2018

The Journal of Arthroplasty

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Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction?

Cited by 121 publications

References 8 publications

Patient Outcomes Following Total Joint Replacement Surgery: A Comparison of Hospitals and Ambulatory Surgery Centers

Patient Outcomes Following Total Joint Replacement Surgery: A Comparison of Hospitals and Ambulatory Surgery Centers

Inpatient versus Outpatient Total Knee Arthroplasty

The American Association of Hip and Knee Surgeons, Hip Society, Knee Society, and American Academy of Orthopaedic Surgeons Position Statement on Outpatient Joint Replacement

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