Outpatient vs. inpatient hip arthroplasty: a matched case-control study on a 90-day complication rate and 2-year patient-reported outcomes

Rosinsky, Philip J.; Chen, Sarah L.; Yelton, Mitchell J.; Lall, Ajay C.; Maldonado, David R.; Shapira, Jacob; Meghpara, Mitchell B.; Domb, Benjamin G.

doi:10.1186/s13018-020-01871-8

Cited by 30 publications

(31 citation statements)

References 38 publications

(45 reference statements)

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“… 3 , 10 - 27 A study comparing the complication rates and patient-reported outcome measures (PROMs) between inpatient and day-case THA showed that at 90 days postoperatively there were no significant differences in complication rates between the two groups, and the latter group experienced better PROMs at two years. 13 Similarly, Coenders et al 26 demonstrated significant improvement in all PROMs at one year following day-case THA, but also significantly lower 90-day complication and readmission rates in day-case THA compared with inpatient THA (4.61% vs 11.54% and 1.38% vs 4.46%, respectively). Moreover, Richards et al 15 conducted a matched cohort analysis that showed lower 90-day complication rates in patients who underwent day-case THA compared to those that were treated as an inpatient post-operatively (8.82% vs 10.29%, respectively).…”

Section: Introductionmentioning

confidence: 92%

“…The decision to use a general anaesthetic (GA) 13 , 15 , 16 , 21 , 25 , 27 or a regional anaesthetic (RA) (spinal or epidural) 3 , 10 - 12 , 14 - 16 , 18 - 27 for day-case THA is debateable. Rosinsky et al 13 is the only study using exclusively a GA as the form of anaesthetic. Berger et al 12 showed in their study involving 150 consecutive day-case THAs successfully discharged home on the same day, that a regional anaesthetic combined with adequate pre-emptive oral analgesia and anti-emetic therapy is an effective method of maximizing day-case discharge.…”

Section: Perioperative Measuresmentioning

confidence: 99%

“… 37 We routinely use tranexamic acid intravenously at induction (1 gram) followed by tranexamic acid wash prior to closure as a method of minimizing blood loss supported by the literature. 10 , 13 , 15 , 20 …”

Section: Perioperative Measuresmentioning

confidence: 99%

“… 39 The asymmetry of baseline characteristics is associated with lower surgical risk favouring patients selected for day-case arthroplasty. 28 Thus, it could be extrapolated that studies demonstrating superior or equivocal complication and readmission rates between day-case and inpatient THA could be secondary to selection bias; 3 , 22 , 24 , 26 however, RCTs 14 and propensity matched studies 13 , 15 , 17 , 26 eliminating this bias have shown superior results favouring day-case pathways.…”

Section: Postoperative Measuresmentioning

confidence: 99%

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Day-case total hip arthroplasty: a literature review and development of a hospital pathway

et al. 2021

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Aims We present the development of a day-case total hip arthroplasty (THA) pathway in a UK National Health Service institution in conjunction with an extensive evidence-based summary of the interventions used to achieve successful day-case THA to which the protocol is founded upon. Methods We performed a prospective audit of day-case THA in our institution as we reinitiate our full capacity elective services. In parallel, we performed a review of the literature reporting complication or readmission rates at ≥ 30-day postoperative following day-case THA. Electronic searches were performed using four databases from the date of inception to November 2020. Relevant studies were identified, data extracted, and qualitative synthesis performed. Results Our evaluation and critique of the evidence-based literature identifies day-case THA to be safe, effective, and economical, benefiting both patients and healthcare systems alike. We further validate this with our institutional elective day surgery arthroplasty pathway (EDSAP) and report a small cohort of successful day-case THA cases as an example in the early stages of this practice in our unit. Conclusion Careful patient selection and education, adequate perioperative considerations, including multimodal analgesia, surgical technique and blood loss management protocols and appropriate postoperative pathways comprising reliable discharge criteria are essential for successful day-case THA. Cite this article: Bone Jt Open 2021;2(2):93–102.

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Section: Introductionmentioning

confidence: 92%

Section: Perioperative Measuresmentioning

confidence: 99%

Section: Perioperative Measuresmentioning

confidence: 99%

Section: Postoperative Measuresmentioning

confidence: 99%

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Day-case total hip arthroplasty: a literature review and development of a hospital pathway

et al. 2021

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“… 3 In appropriately selected patients, outpatient TJA has been shown to be safe and effective, resulting in decreased hospital stays and reduced economic burden to the healthcare system without increasing complications, readmissions, or emergency department (ED) visits. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Furthermore, a recent large database study found that contemporary outpatient TJA is associated with fewer adverse events when matched to inpatient procedures. 20 Compared with inpatient TJA, patients who undergo outpatient TJA may also have higher satisfaction and improved patient-reported outcomes.…”

mentioning

confidence: 99%

Outpatient Total Hip and Knee Arthroplasty Performed in a Safety Net Hospital System

Kay¹,

Taylor²,

Tye³

et al. 2021

JAAOS Glob Res Rev

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Introduction: High-percentage outpatient total joint arthroplasty (TJA) performed in a safety net hospital system has not been described. A rapid recovery protocol (RRP) was instituted at our safety net hospital that allowed eventual transition to outpatient TJA. Methods: Retrospective review of all primary total knee and hip arthroplasty performed by a single surgeon (RR) using an RRP was performed. The initial cohort of patients was monitored overnight with the goal of next-day discharge (n = 57), and as the RRP evolved, the subsequent cohort of patients had the possibility of same-day discharge (PSDD, n = 61). Outcome measures included the rate of same-day discharge in the PSDD cohort and short-term adverse event rates. Results: In the PSDD cohort, 86.9% (n = 53) of patients were successfully discharged on the day of surgery, and hospital length of stay was decreased by 17.7 hours (13.5 versus 31.2 hours, P < 0.0001). Comparing the next-day discharge and PSDD groups, no significant differences were found in 30-day emergency department visits (5.3% versus 3.3%, P = 0.67), 90-day complications (15.8% versus 13.1%, P = 0.79), 90-day readmissions (0% versus 3.3%, P = 0.50), or 90-day revision surgeries (0% versus 3.3%, P = 0.50). Conclusions: This study demonstrates that the transition to outpatient TJA can be successfully performed in a safety net hospital system without increasing short-term adverse events.

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Inpatient Versus Outpatient Surgery: A Comparison of Postoperative Mortality and Morbidity in Elective Operations

et al. 2022

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Background Operations performed outpatient offer several benefits. The prevalence of outpatient operations is growing. Consequently, the proportion of patients with multiple comorbidities undergoing outpatient surgery is increasing. We compared 30‐day mortality and overall morbidity between outpatient and inpatient elective operations. Methods Using the 2005–2018 ACS‐NSQIP database, we evaluated trends in percent of hospital outpatient operations performed over time, and the percent of operations done outpatient versus inpatient by CPT code. Patient characteristics were compared for outpatient versus inpatient operations. We compared unadjusted and risk‐adjusted 30‐day mortality and morbidity for inpatient and outpatient operations. Results A total of 6,494,298 patients were included. The proportion of outpatient operations increased over time, from 37.8% in 2005 to 48.2% in 2018. We analyzed the 50 most frequent operations performed outpatient versus inpatient 25–75% of the time (n = 1,743,097). Patients having outpatient operations were younger (51.6 vs 54.6 years), female (70.3% vs 67.3%), had fewer comorbidities, and lower ASA class (I–II, 69.3% vs. 59.9%). On both unadjusted and risk‐adjusted analysis, 30‐day mortality and overall morbidity were less likely in outpatient versus inpatient operations. Conclusion In this large multi‐specialty analysis, we found that patients undergoing outpatient surgery had lower risk of 30‐day morbidity and mortality than those undergoing the same inpatient operation. Patients having outpatient surgery were generally healthier, suggesting careful patient selection occurred even with increasing outpatient operation frequency. Patients and providers can feel reassured that outpatient operations are a safe, reasonable option for selected patients.

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Outpatient vs. inpatient hip arthroplasty: a matched case-control study on a 90-day complication rate and 2-year patient-reported outcomes

Cited by 30 publications

References 38 publications

Day-case total hip arthroplasty: a literature review and development of a hospital pathway

Day-case total hip arthroplasty: a literature review and development of a hospital pathway

Outpatient Total Hip and Knee Arthroplasty Performed in a Safety Net Hospital System

Inpatient Versus Outpatient Surgery: A Comparison of Postoperative Mortality and Morbidity in Elective Operations

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