Outpatient Primary Total Hip Arthroplasty Is a Safe Alternative to Inpatient Primary Total Hip Arthroplasty: A Matched-Cohort Analysis Study

Abstract

Introduction: Outpatient primary total hip arthroplasty (THA) accounts for approximately 8% of all total hip arthroplasties (THA) performed annually in the United States. As of 2020, Medicare removed THA from its inpatient-only list, allowing reimbursement as an outpatient procedure. This study aimed to determine whether outpatient primary THA is a potential alternative to inpatient procedures by assessing: 1) 90-day postoperative complications; 2) readmission rates; and 3) total costs of care.

The Arthroplasty Surgeon Growth Indicator

“…The underlying concern regarding how to best maintain health-care quality, increase access to care, and enhance cost-efficiency despite growing surgeon supply deficits may have various solutions. Recent regulatory and reimbursement changes, which saw the removal of THA 36 and TKA 37 from the Medicare inpatient-only list, may enable a substantial shift toward outpatient arthroplasties and help to decrease the economic impact of inpatient hospitalizations. Increasing utilization of highly efficient, high-throughput surgical centers may also help to ramp up the surgical volume to accommodate the need 38,39 .…”

National Inpatient Datasets May No Longer Be Appropriate for Overall Total Hip and Knee Arthroplasties Projections after Removal from Inpatient-Only Lists

“…Such limitation is expected to impact investigations in an incremental fashion starting 2018 for TKA and 2020 for THA, as recent trends indicate a progressive increase in the proportion of outpatient THA/TKA relative to the total surgical volume. [15][16][17] While projected THA and TKA volumes have demonstrated marked dissimilarity over the past decade, all estimates invariably predicted an exponential rise in utilization rates. THA predictions showed a consistent, exponential rise similar to previous estimates.…”

“…This has been followed by rapid and progressive popularization of outpatient THA and TKA. By current estimates, 8% and 5% of all THAs and TKAs are performed in the outpatient setting, respectively 15,16 . However, outpatient or single-day discharge TKA has been noted to be increasing at a mean annual rate of 11% 17 , with current evidence pointing towards a growing rate of adoption of outpatient TKA.…”

“…trends indicate a progressive increase in the proportion of outpatient THA/TKA relative to the total surgical volume[15][16][17] .While projected THA and TKA volumes have demonstrated marked dissimilarity over the past decade, all estimates invariably predicted an exponential rise in utilization rates. The most cited prediction byKurtz et al 3 utilized NIS data from 1990 to 2003 and estimated 572,000 THAs and 3.48 million TKAs by 2030.…”

“…By current estimates, 8 and 5% of all THAs and TKAs are performed in the outpatient setting, respectively. 15,16 However, outpatient or single-day discharge TKA has been noted to be increasing at a mean annual rate of 11%, 17 with current evidence pointing toward a growing rate of adoption of outpatient TKA. Such outpatient surgeries are not captured by the NIS; thereby, potentially ending an $3 decade-long record of suitability for nationwide THA/TKA projections.…”