An Evaluation of the Safety and Effectiveness of Total Hip Arthroplasty as an Outpatient Procedure: A Matched-Cohort Analysis

Richards, Megan; Alyousif, Hussein; Kim, Jung-Kyong; Poitras, Stéphane; Penning, John; Beaulé, Paul E.

doi:10.1016/j.arth.2018.05.036

Cited by 63 publications

(40 citation statements)

References 23 publications

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“…(2017) and Richards et al. (2018) reported 30-day readmission rates of 8%, while Berger et al. (2005) reported a 6% readmission rate within 90 days.…”

Section: Discussionmentioning

confidence: 99%

Complications and readmissions following outpatient total hip and knee arthroplasty: a prospective 2-center study with matched controls

et al. 2019

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Background and purpose — Outpatient arthroplasty has gained popularity in recent years; however, safety concerns still remain regarding complications and readmissions. In a prospective 2-center study we investigated early readmissions with overnight stay and complications following outpatient total hip (THA) and total knee arthroplasty (TKA) compared with a matched patient cohort with at least 1 postoperative night in hospital. Patients and methods — All consecutive and unselected patients scheduled for THA or TKA at 2 participating hospitals were screened for potential day of surgery (DOS) discharge. Patients who fulfilled the DOS discharge criteria were discharged home. Patients discharged on DOS were matched on preoperative characteristics using propensity scores to patients operated at the same 2 departments prior to the beginning of this study with at least 1 overnight stay. All readmissions within 90 days were identified. Results — It was possible to match 116 of 138 outpatients with 339 inpatient controls. Median LOS in the control cohort was 2 days (1–9). 7 (6%) outpatients and 13 (4%) inpatient controls were readmitted within 90 days. Readmissions occurred between postoperative day 2–48 and day 4–58 in the outpatient and control cohorts, respectively. Importantly, we found no readmissions within the first 48 hours and no readmissions were related to the DOS discharge. Interpretation — Readmission rates in patients discharged on DOS may be similar to matched patients with at least 1 overnight stay. With the selection criteria used, there may be no safety signal associated with same-day discharge.

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“…(2017) and Richards et al. (2018) reported 30-day readmission rates of 8%, while Berger et al. (2005) reported a 6% readmission rate within 90 days.…”

Section: Discussionmentioning

confidence: 99%

Complications and readmissions following outpatient total hip and knee arthroplasty: a prospective 2-center study with matched controls

et al. 2019

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“…Rapid recovery for primary TJA has been successfully performed in multiple patient populations, with low rates of complications and readmissions, even among elderly patients [ 16 , [27] , [28] , [29] ]. In its current state, appropriately performed rapid recovery primary TJA is a safe [ 30 ], cost-efficient [ 14 , 31 , 32 ], and patient-friendly strategy [ 33 ]. However, there remains disagreement on the optimal inpatient LOS, with some authors criticizing outpatient TJA as risky and claiming longer inpatient stays allow for the recognition of life-threatening complications and those complications that prompt readmission [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Safety of Same and Next Day Discharge Following Revision Hip and Knee Arthroplasty Using Modern Perioperative Protocols

Buller

Hubbard

Ziemba-Davis

et al. 2021

The Journal of Arthroplasty

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Background Advances in perioperative care have enabled early discharge and outpatient primary total joint arthroplasty (TJA). However, the safety of early discharge after revision TJA (rTJA) remains unknown and the COVID-19 pandemic will force decreased hospitalization. This study compared 90-day outcomes in patients undergoing aseptic rTJA discharged the same or next day (early) to those discharged 2 or 3 days postoperatively (later). Methods In total, 530 aseptic rTJAs performed at a single tertiary care referral center (December 5, 2011 to December 30, 2019) were identified. Early and later discharge patients were matched as closely as possible on procedure type, sex, American Society of Anesthesiologists physical status classification, age, and body mass index. All patients were optimized using modern perioperative protocols. The rate of 90-day emergency department (ED) visits and hospital admissions was compared between groups. Results In total, 183 early discharge rTJAs (54 hips, 129 knees) in 178 patients were matched to 183 later discharge rTJAs (71 hips, 112 knees) in 165 patients. Sixty-two percent of the sample was female, with an overall average age and body mass index of 63 ± 9.9 (range: 18-92) years and 32 ± 6.9 (range: 18-58) kg/m 2 . There was no statistical difference in 90-day ED visit rates between early (6/178, 3.4%) and later (11/165, 6.7%) discharge patients ( P = .214). Ninety-day hospital admission rates for early (7/178, 3.9%) and later (4/165, 2.4%) discharges did not differ ( P = .545). Conclusion Using modern perioperative protocols with appropriate patient selection, early discharge following aseptic rTJA does not increase 90-day readmissions or ED visits. As hospital inpatient capacity remains limited due to COVID-19, select rTJA patients may safely discharge home the same or next day to preserve hospital beds and resources for more critical illness.

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“…High-volume surgeries may generate a considerable number of adverse events (AEs). The AE rate following elective total hip arthroplasty ranges from 4.1% to 10% (Huddleston et al 2012, Bohl et al 2016, Richards et al 2018.…”

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confidence: 99%

Only 8% of major preventable adverse events after hip arthroplasty are filed as claims: a Swedish multi-center cohort study on 1,998 patients

et al. 2019

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An Evaluation of the Safety and Effectiveness of Total Hip Arthroplasty as an Outpatient Procedure: A Matched-Cohort Analysis

Cited by 63 publications

References 23 publications

Complications and readmissions following outpatient total hip and knee arthroplasty: a prospective 2-center study with matched controls

Complications and readmissions following outpatient total hip and knee arthroplasty: a prospective 2-center study with matched controls

Safety of Same and Next Day Discharge Following Revision Hip and Knee Arthroplasty Using Modern Perioperative Protocols

Only 8% of major preventable adverse events after hip arthroplasty are filed as claims: a Swedish multi-center cohort study on 1,998 patients

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