Total Joint Arthroplasty in a Stand-alone Ambulatory Surgical Center: Short-term Outcomes

Abstract

A mbulatory surgical centers (ASCs) offer surgeons an effective setting to perform procedures that do not require prolonged postoperative monitoring or an inpatient hospital stay. Advances in minimally invasive surgical techniques, short-acting general anesthetics, long-acting local anesthetics, and blood loss management have improved the safety and recovery for many orthopedic procedures. These changes to perioperative care have reduced the need for postoperative hospitalization in many surgical specialties. As a result, the number of procedures performed in the ambulatory setting has grown significantly. The health care market has been pushing for an increased quality of care at a lower cost. Ambulatory surgical centers provide an average 84% cost reduction in proce-

Definitional Differences of ‘Outpatient’ Versus ‘Inpatient’ THA and TKA Can Affect Study Outcomes

“…The benefits of outpatient arthroplasty are reported to include higher patient satisfaction and reduced costs [15,29]. Multiple studies comparing the outcomes of inpatient with outpatient arthroplasty have been reported [2,5,9,10,15,16,24,25,29,30,37,40,48]. However, the difference between ''inpatient'' and ''outpatient'' is not as intuitive as one might think.…”

“…The recent changes in healthcare insurance and the aging US population make the appropriate exploration of outpatient procedures in terms of safety and cost-effectiveness more important than ever. The large number of recent orthopaedic studies comparing inpatient and outpatient procedures underscores this importance [2,5,9,10,15,16,24,25,29,30,37,40,48].…”

“…This ''observation'' status obscures the division between what is considered inpatient or outpatient. Some studies on outpatient arthroplasty have defined ''outpatient'' status as patients who were discharged the same day [5,9,10], patients who stayed at most one night at the hospital [2,4,24], patients who stayed at most two nights at the hospital [15,25], or simply provided stated status with no quantitative description [16,29,40].…”

Establishing a Successful Outpatient Joint Arthroplasty Program

“…Not all patients are candidates for outpatient joint arthroplasty (OJA); however, careful selection of appropriate patients can allow for successful outpatient surgery and recovery at home. Assessing surgical risk is necessary to determine which patients are best suited for this type of postoperative care . Although the tools for selecting suitable candidates are still being refined, several tools are currently used .…”

“…Although the tools for selecting suitable candidates are still being refined, several tools are currently used . The American Society of Anesthesiologists’ classification, the Charlson comorbidity index (CCI), and the Outpatient Arthroplasty Risk Assessment all have merit . The American Society of Anesthesiologists’ rating scale measures fitness for surgery .…”