Outpatient Total Hip Arthroplasty Has Minimal Short-Term Complications With the Use of Institutional Protocols

Weiser, Mitchell C.; Kim, Kelvin Y.; Anoushiravani, Afshin A.; Iorio, Richard; Davidovitch, Roy I.

doi:10.1016/j.arth.2018.07.015

Cited by 76 publications

(49 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There may be inherent biases that have arisen owing to the single-site, single-surgeon, and retrospective nature of this study. Furthermore, the failure-tolaunch rate for SDD patients in this study was 10.4%, which represents an improvement over rates in the early years of our SDD program but is nonetheless not insignificant [9]. Pain, nausea, and hypotension have been cited as the most common reasons for a longer-than-expected hospital stay in an outpatient arthroplasty population [10].…”

Section: Discussionmentioning

confidence: 55%

“…Favorable reports from several centers have been published over the past decade. A study on outcomes in 164 patients who underwent early SDD THA at our institution (from January 2015 to September 2016) was previously published [9]. Patients were analyzed against an inpatient cohort of 1315 patients with Risk for Readmission Assessment Tool scores 2.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: There has been increasing interest in performing primary hip and knee replacement with same-day discharge (SDD). The purpose of this study is to compare patient-reported outcome (PRO) scores, pain scores, and readmissions in patients who underwent SDD total hip arthroplasty (THA) with those in patients who underwent traditional inpatient THA. Methods: A retrospective study was conducted on 963 patients who underwent primary THA at our institution between September 2016 and December 2018. Two cohorts were established based on whether the patient underwent SDD or traditional inpatient THA. An electronic physical engagement application was used to collect PRO scores (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, Veterans Rand 12-Item Health Survey Physical Component Score, and Mental Component Score) and pain scores. To control for demographic variables, a multiple regression analysis of PRO scores was conducted. Results: Four hundred fifteen (43.1%) patients in this study underwent the SDD protocol. There were significant differences between both cohorts with respect to sex, age, body mass index, American Society of Anesthesiologists score, and smoking status. The bivariate analysis revealed that the SDD cohort had a significantly greater change in the Veterans Rand 12-Item Health Survey Physical Component Score and had fewer readmissions. Both cohorts had equivalent decreases in pain scores. After controlling for demographic variables in a multivariable analysis, the SDD cohort was found to have higher PRO scores at all time points, but there were no significant differences in the change in PRO scores over time between both groups. Conclusions: Patients in an SDD THA care pathway experienced similar improvements in PRO scores and clinically equal reduction in pain scores.

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…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 ].…”

mentioning

confidence: 99%

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

Kraus

Buller

Caccavallo³

et al. 2021

The Journal of Arthroplasty

View full text Add to dashboard Cite

Background Total joint arthoplasty (TJA) cost containment has been a key focus for the Centers for Medicare and Medicaid Services spawning significant research and programmatic change, including a move toward early discharge and outpatient TJA. TJA outpatients receive few, if any, medical interventions before discharge, but the type and quantity of interventions provided for TJA patients who stay overnight in the hospital is unknown. This study quantified the nature, frequency, and outcome of interventions occurring overnight after primary TJA. Methods 1725 consecutive primary unilateral TJAs performed between 2012 and 2017 by a single surgeon in a rapid-discharge program, managed by a perioperative internal medicine specialist, were reviewed. Medical records were examined for diagnostic tests, treatments, and procedures, results of interventions, and readmissions. Results 759 patients were discharged on postoperative day 1. Eighty-four percent (641 of 759) received no medical interventions during their overnight hospital stay. Twelve (1.6%) received diagnostic tests, 90 (11.9%) received treatments, and 29 (3.8%) received procedures. Ninety-two percent (11 of 12) of diagnostic tests were negative, 66% of 100 treatments in 90 patients were intravenous fluids for oliguria or hypotension, and all procedures were in and out catheterizations for urinary retention. 90-day all-cause readmission rates were similar in patients who received (2.5%) and did not receive (3.3%) a clinical intervention. Conclusion Most patients received no overnight interventions, suggesting unnecessary costly hospitalization. The most common issues addressed were oliguria, urinary retention, and hypotension. Protocols to prevent these conditions would facilitate outpatient TJA, improve patient safety, and reduce costs.

show abstract

“…Our experience and the findings of this study have allowed us to expand our indications for SDD THA to an increasing number of patients. In our institution, we do not limit SDD THA to patients based on age or insurance status but rather use validated screening tools and shared decisionmaking when indicating patients and have found success with this methodology [24]. We suggest that certain healthy, motivated Medicare patients are candidates for SDD THA, but that the decision to proceed with outpatient THA be based on each patient's unique clinical picture.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Same-Day Discharge After Total Hip Arthroplasty in the Medicare Population

Feder

Lygrisse

Hutzler

et al. 2020

The Journal of Arthroplasty

Self Cite

View full text Add to dashboard Cite

Outpatient Total Hip Arthroplasty Has Minimal Short-Term Complications With the Use of Institutional Protocols

Cited by 76 publications

References 31 publications

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

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

Outcomes of Same-Day Discharge After Total Hip Arthroplasty in the Medicare Population

Contact Info

Product

Resources

About