Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database

Courtney, P. Maxwell; Boniello, Anthony J.; Berger, Richard A.

doi:10.1016/j.arth.2016.11.055

Cited by 227 publications

(157 citation statements)

References 18 publications

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“…The authors found that a patient's length of stay had the greatest in uence on the cost of 90-day readmissions [30]. In studies on outpatient TJA, rates of 90-day readmission are very low, at approximately 0.5%-1% [29,31].…”

Section: Discussionmentioning

confidence: 99%

“…In several studies, in appropriately selected patients, complications have been shown to be equal or lower in patients undergoing outpatient THA. Courtney et al analyzed the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database and found an 8% complication rate in the outpatient setting compared to a 16% complication rate in the inpatient setting [31]. Arshi et al, performed a registry-based study on 2,184 patients undergoing outpatient THA, and found comparable rates of surgical and medical complications [33].…”

Section: Discussionmentioning

confidence: 99%

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Outpatient vs. Inpatient Hip Arthroplasty: A Matched Case-Control Study on 90-Day Complication Rate and 2-Year Patient Reported Outcomes

Rosinsky

Chen

Yelton

et al. 2020

Preprint

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Background: The transition to outpatient-based surgery is a major development occurring in recent years in the field of total hip arthroplasty (THA). The effect of this transition on patient reported outcomes (PROs) is still not well established. The purpose of the current study was to compare patients undergoing inpatient THA (iTHA) to patients undergoing outpatient THA (oTHA) regarding (1) perioperative variables including: surgical time, blood loss, and length of stay (2) 90-day complication rates and unplanned emergency room or office visits (3) 2-year PROs including: modified Harris hip score (mHHS), Harris hip score (HHS), forgotten joint score (FJS), pain, and satisfaction, as well as quality of live measures. Methods: The XXX registry was analyzed for patients undergoing THA between July 2014 and April 2016. The first 100 patients undergoing oTHA were selected and matched to 100 patients undergoing iTHA via propensity matching based on the following variables: age, sex, body mass index (BMI), Charlson comorbidity index (CCI), and smoking status. The primary outcomes were PROs at two years post-operatively. The secondary outcomes were perioperative surgical variables, 90-day complication rates, and unplanned emergency and clinic visits. Results: After exclusions, 91 patients remained in each group and were compared. The oTHA group showed improved 2-year PROs with regard to mHHS (91.5 vs. 86.2; P=0.02), HHS (92.3 vs. 87.4; P=0.02), and pain (1.0 vs. 1.5; P=0.04). The oTHA group had an average length of stay of 6.8 hours compared to 43.2 hours for the iTHA group (P<0.001). There were no significant differences between the groups regarding readmissions, emergency room visits, and unplanned clinic visits. Complications and revision rates were similar in both groups. Conclusion: In appropriately selected, younger patients, oTHA can achieve improved postoperative 2-year PROs compared to iTHA. We found no differences regarding postoperative short-term complications or two-year revision rates, and no differences in unplanned office visits or readmissions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outpatient vs. Inpatient Hip Arthroplasty: A Matched Case-Control Study on 90-Day Complication Rate and 2-Year Patient Reported Outcomes

Rosinsky

Chen

Yelton

et al. 2020

Preprint

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“…Cardiovascular disease, poorly controlled diabetes, opioid use, malnutrition, smoking, neurocognitive, psychological, behavioral problems, and physical deconditioning are potentially modifiable risk factors that have been implicated in longer LOS, increased complications, more early revisions, and increased readmissions following elective TKA. 56,[58][59][60][61][62][63][64][65][66][67][68][69] At our institution, a review of all revision total knee replacements performed within 2 years of the index surgery demonstrated $44% had at least one modifiable risk factor (body mass index [BMI] > 40, hemoglobin A1c > 8, poor dentition, and smoking status) present at the time of revision surgery. 70 Infected knee revision patients were more likely to smoke, have poor dentition, and have > 1 modifiable risk factor compared with noninfected patients.…”

Section: Modifiable Risk Factorsmentioning

confidence: 99%

Preoperative Care of the TKA Patient

2018

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Total knee arthroplasty continues to increase in popularity and remains the most common joint replacement surgery. The success of total knee replacement surgery is attributed to improved outcomes, a better patient experience, and lower cost. Rapid recovery total knee replacement protocols have led to these advances by decreasing length of hospital stay, minimizing readmissions, and reducing the cost of surgery. Rapid recovery total knee replacement pathway efforts should focus on preoperative education, optimization of modifiable risk factors, and identification of patients that may not be suitable for this pathway.

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“…However, the ndings regarding the risk of short-term complications in patients with shorter hospital stays have been con icting. Some studies have suggested that outpatient hip and knee arthroplasty may have higher rates of short-term complications relative to inpatient procedures, while others have suggested that there is not a substantial difference in short-term outcome measures between the two groups (15)(16)(17). Many of these studies have utilized national databases that provide large enough sample sizes to investigate even the rarest of complications.…”

Section: Introductionmentioning

confidence: 99%

A Propensity-Score Matched Analysis Comparing Outpatient and Short-Stay Hospitalization to Standard Inpatient Hospitalization Following Total Ankle Arthroplasty

Plantz¹,

Sherman²,

Kadakia³

2020

Preprint

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Background Given the trend toward value-based care, there has been increased interest in minimizing hospital length of stay (LOS) after orthopaedic procedures. Outpatient total ankle arthroplasty (TAA) has become more popular in recent years; however, research on surgical outcomes of this procedure has been limited. This study sought to emply large sample, propensity-score matched analyses to assess the safety of outpatient and short-stay discharge pathways following TAA. Methods The ACS NSQIP database was used to identify 1,141 patients who underwent primary and revision TAA between 2007 and 2017. Propensity score matching was used to match patients based on several factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and several comorbidities. The incidence of various 30-day complications were compared between the short and standard LOS groups to assess for any differences in short-term outcomes. Results A total of 892 patients were included in the final propensity score matched analysis, with 446 patients in each group. The short LOS group had a significantly lower rate of medical complications (0.2% vs. 2.5%, p = 0.006) and non-home discharge (1.3% vs. 12.1%, p < 0.001). There was no significant difference in operative complications (0.4% vs. 1.8%, p = 0.107), unplanned readmission (0.4% vs. 1.1%, p = 0.451), reoperation (0.2% vs. 0.4%, p > 0.999), return to the OR (0.2% vs. 0.9%, p = 0.374), or mortality (0.7% vs. 0.0%, p > 0.249) between the short and standard LOS groups. Conclusions Outpatient and short-stay hospitalization had comparable safety to standard inpatient hospitalization after TAA. Outpatient or short-stay TAA should be considered for patients with low risk of short-term complications.

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Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database

Cited by 227 publications

References 18 publications

Outpatient vs. Inpatient Hip Arthroplasty: A Matched Case-Control Study on 90-Day Complication Rate and 2-Year Patient Reported Outcomes

Outpatient vs. Inpatient Hip Arthroplasty: A Matched Case-Control Study on 90-Day Complication Rate and 2-Year Patient Reported Outcomes

Preoperative Care of the TKA Patient

A Propensity-Score Matched Analysis Comparing Outpatient and Short-Stay Hospitalization to Standard Inpatient Hospitalization Following Total Ankle Arthroplasty

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