Outcomes of the First 1,000 Total Hip and Total Knee Arthroplasties at a Same-day Surgery Center Using a Rapid-recovery Protocol

Abstract

Background: Outpatient (<24 hour stay) total joint arthroplasty (TJA) has emerged as an alternative to traditional inpatient TJA. Patient-reported outcomes in the past have revealed favorable comparisons with inpatient controls. However, a higher outpatient TJA readmission rate has been reported. The goal of our study is to report outcomes, readmissions, and unplanned access to care data on the first 1,000 TJAs performed at a de novo ambulatory surgery center (ASC). Methods: From March 2014 to May 2016, a consecutive series of 1,000 primary, total hip, and total knee arthroplasties (TKAs) were performed at a same-day surgical center. All patients were ≤66 years old, met the ASC inclusion criteria, and received preoperative training. All patients were discharged <24 hours after surgery to postoperative care suites. Oxford scores, visual analog scale for pain, patient satisfaction, ambulation, complication, and adverse events data were collected. Results: A consecutive series of 543 TKAs and 457 total hip arthroplasties (THAs) were performed. Mean age was 57.2 years (range 28 to 66 years). The TKA patients consisted of 55.2% women, whereas THA patients consisted of 45.3% women. Overall infection rate was 0.8%. Hospital readmission rate was 1.5%, and early/unplanned access to care was 11.7%. Oxford Knee and Oxford Hip scores showed 15.7 and 21.1 point improvements, respectively, whereas pain scores improved 71% for TKA and 81% for THA at 6 months postoperatively ( P < 0.01). Conclusions: Our immediate and short-term complications, readmissions, and outcomes for all patients compared favorably with published inpatient data. This study provides baseline data for quality metrics and functional outcomes for ASC-based total joint procedures.

Is There Benefit in Keeping Early Discharge Patients Overnight After Total Joint Arthroplasty?

“…However, there is disagreement regarding the optimal inpatient length of stay. Some surgeons cite early discharge TJA as safe [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ] and without increased readmission rates [ [15] , [16] , [17] ], whereas others criticize early discharge TJA as risky, claiming inpatient stays allow for the recognition of life-threatening complications and those complications that prompt readmission [ [19] , [20] , [21] ]. With the removal of TKA from the inpatient-only list, hospitals and payers must now consider all Medicare TKA patients as potential outpatients [ 30 ].…”

“…These developments have become part of Centers for Medicare and Medicaid Services efforts to contain costs while maintaining the safety and quality of TJA. Evidence has demonstrated early discharge TJA to be safe [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ] and cost saving [ 13 , 14 ], without increasing readmission rates [ [15] , [16] , [17] ]. In fact, the paradigm has shifted, and in the modern context, prolonged inpatient lengths of stay have been associated with higher unplanned 90-day readmission rates [ 18 ].…”

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

“…Patients having THA or TKA are generally satisfied with their overall experiences (Husted et al 2008, Hoeffel et al 2019.…”

Outpatient total knee arthroplasty: is it economically feasible in the hospital setting?

“…The move to the outpatient setting has been largely facilitated by less invasive surgical techniques and improvements in pain management and adoption and improvement of enhanced recovery after surgery (ERAS) pathways [5][6][7][8]. Initially, there was concern that the cost of additional services required by patients who underwent outpatient TJA would outweigh benefits, but more recent studies have shown that outpatient TJA can be a successful and safe option in selected patients [9][10][11][12][13], with high patient satisfaction [14] and low complication rates [8].…”