Same Day Total Hip Arthroplasty Performed at an Ambulatory Surgical Center: 90-Day Complication Rate on 549 Patients

As a result of the introduction of fast-track programs, the length of hospital stay after arthroplasty has decreased to a point where some patients meet the discharge criteria on the day of surgery. In several studies, well-established fast-track centers have demonstrated the feasibility of outpatient procedures in selected patients. However, in literature the term “outpatient” is sometimes also used for patients who spend one or more nights in hospital. We therefore propose to use “outpatient” solely for patients who are discharged to their own home on the day of surgery and do not have an overnight stay at either the hospital or another non-home facility. Also, several challenges need to be overcome before this becomes an established procedure. The combination of preoperative high-dose steroids and multimodal opioid-sparing analgesia has enhanced patient recovery after arthroplasty, but efforts to control undesirable pathophysiological responses will be a prerequisite to improve the success rate of an outpatient setting. Also, care must be taken to avoid extra activities or investments solely to enable discharge on the day of surgery. Further cost analyses will have to be performed to establish the true financial benefit of outpatient treatment.

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“… 2016 , Klein et al. 2017 ). However, in inpatient hospitals, the reduced cost associated with outpatient treatment is more difficult to assess.…”

Section: Economic Benefits Of Outpatient Tjamentioning

confidence: 99%

Outpatient total hip and knee arthroplasty

2017

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“…There has been a trend toward short hospitalizations, which has been facilitated by refinements in surgical techniques, advancements in pharmacologic regimens, and modification of postoperative physical therapy pathways. The development of such clinical efficiencies, such as comprehensive pre and perioperative pathways, has allowed for the development of truly outpatient or ambulatory total joint surgery [2] , [3] , [4] , [5] , [6] . Today, there is an increasing interest in outpatient TJA as there are perceived advantages for the patient, potential cost reduction [7] , and general benefits to the health-care system.…”

Section: Introductionmentioning

confidence: 99%

Is it safe? Outpatient total joint arthroplasty with discharge to home at a freestanding ambulatory surgical center

et al. 2018

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BackgroundTotal joint arthroplasty (TJA) is trending toward shorter hospitalizations; as a result, there are many ambulatory surgical centers (ASCs) starting to perform outpatient TJA. However, there are limited studies examining the safety of outpatient TJA in the freestanding ASC setting. This study aims to evaluate 30-day and 90-day complication rates in patients who underwent outpatient TJA at a freestanding, independent ASC with direct discharge to home.MethodsA retrospective cohort review using health records was performed on the first 115 TJAs performed between August 2015 and March 2017 by one of the 4 orthopedic surgeons. Before the first TJA, the ASC had developed a multidisciplinary TJA pathway.ResultsOf the 115 TJAs, 37 (32%) were total hip arthroplasties (THAs), 53 (46%) total knee arthroplasties (TKAs), and 25 (22%) unicompartmental knee arthroplasties, with a mean age of 57 ± 7 years and body mass index of 30 ± 5 kg/m2. There were no intraoperative or direct ASC-related complications. There was 1 instance (0.9%) of a postoperative minimally displaced intertrochanteric femur fracture after THA due to a fall treated nonoperatively complication within 30 days of surgery. Of the 90-day complication events, there were 2 patients (2%) with postoperative arthrofibrosis of the knee after TKA requiring manipulation under anesthesia, 1 postoperative patellar tendon rupture during therapy after TKA requiring surgical repair and 1 delayed hematogenous infection after international travel after THA requiring 2-staged exchange.ConclusionsOutpatient TJA with discharge to home at a freestanding, independent ASC is a safe option after development of a multidisciplinary TJA pathway.

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“…[1,5,8,11] Rapid recovery protocols have created a natural evolution from the inpatient to the outpatient setting. [2,3,6,10,[12][13][14] Outpatient total joint arthroplasty (TJA) has been successfully performed during the past decade [4,13,[15][16][17][18][19][20], albeit for the most part by highly experienced surgeons with carefully selected patients. Success has been attributed to multidisciplinary care coordination, standardized perioperative protocols, discharge planning, and careful patient selection.…”

Section: Introductionmentioning

confidence: 99%