Inpatient Versus Outpatient Arthroplasty: A Single-Surgeon, Matched Cohort Analysis of 90-Day Complications

Darrith, Brian; Frisch, Nicholas B.; Tetreault, Matthew W.; Fice, Michael P.; Culvern, Chris; Valle, Craig J. Della

doi:10.1016/j.arth.2018.10.015

Cited by 84 publications

(54 citation statements)

References 28 publications

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“…Over the last 4 decades, advancements in implant designs, improvement in surgical techniques and instrumentation, and development of rapid recovery protocols have significantly contributed to reducing the length of stay (LOS) and recovery time after TKA [5,6]. In 2018, The Centers for Medicare and Medicaid Services removed TKA from its inpatient-only list, allowing medically and socially optimized patients to discharge home on the same day or next day after TKA [7,8]. Building on the removal of TKA from the inpatient-only list, Centers for Medicare and Medicaid Services has approved the performance of TKA in ambulatory surgery centers (ASCs) as of January 1, 2020.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

et al. 2021

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Background: In January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA. Methods: A retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 oneday length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conducted. Multiple logistic regression was used to evaluate predictors of SDD, as these patients represent those most likely to safely undergo TKA in an ASC. Results: Controlling for other demographics and comorbidities, patients with the following characteristics were at reduced odds of SDD: increased age (odds ratio [OR] ¼ 0.935, P < .001), body mass index !35 (OR ¼ 0.491, P ¼ .002), female (OR ¼ 0.535, P < .001), nonwhite race (OR ¼ 0.456, P ¼ .003), primary hypertension (OR ¼ 0.710, P ¼ .032), !3 comorbidities (OR ¼ 0.507, P ¼ .002), American Society of Anesthesiologists score !3 (OR ¼ 0.378, P < .001). The model was deemed to be of adequate fit using the Hosmer and Lemeshow test (c 2 ¼ 12.437, P ¼ .112), and the area under the curve was found to be 0.773 indicating acceptable discrimination. Conclusion: For patients undergoing primary TKA, increased age, body mass index !35, female gender, nonwhite race, primary hypertension, !3 comorbidities, and American Society of Anesthesiologists score !3 decrease the likelihood of SDD. A predictive model based on readily available patient presentation and comorbidity characteristics may aid surgeons in identifying patients that are candidates for SDD or ASC-based TKA.

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Section: Introductionmentioning

confidence: 99%

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

et al. 2021

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“…In addition, we wanted to document any differences in readmission rates between cases coded as inpatient and those coded as outpatient after controlling for other factors. Prior research on the relationship between inpatient vs outpatient status and readmission rates had been limited to a single surgeon [3], a single institution [4], or older data prior to the removal of the IPO rule for TKAs [5,6].…”

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confidence: 99%

An Examination of the Adoption of Outpatient Total Knee Arthroplasty Since 2018

Barnes

Iorio

Zhang³

et al. 2020

The Journal of Arthroplasty

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Background: The Centers for Medicare and Medicaid Services removed total knee arthroplasties (TKAs) from the inpatient-only (IPO) list on January 1, 2018, which meant that TKAs could be performed on a hospital outpatient basis. We examined the following: (1) the national rate of adoption of outpatient TKAs over time, (2) how adoption varied across hospitals, and (3) whether adoption of outpatient TKAs has positively or negatively impacted 90-day TKA readmission rates. Methods: We used national patient-level Medicare Fee-for-Service Part A claims data (100% sample) from January 2017 through June 2019 to look at the quarterly trend in percent of TKAs performed as outpatient, and the distribution in this percentage across hospitals in the country. We ran a case-level regression to understand whether inpatient vs outpatient coding status relates to 90-day readmission rates. Results: In 2017 prior to the removal of TKAs from the IPO list, 0.2% were performed as outpatient. In the first quarter (Q1 2018) after the rule change, 24.9% were performed as outpatient, and by the second quarter of 2019, 36.4% were performed as outpatient. These rates varied widely across hospitals from 0% (10th and 25th percentiles) to 78% (90th percentile) from January 2018 through March 2019. There was no difference in readmission rates for same-day discharges, but outpatient cases discharged after one or more nights in the hospital had statistically lower readmissions than inpatient cases. Conclusion: There was a rapid increase in the adoption of hospital outpatient TKAs following their removal from the Medicare IPO, which has resulted in lower readmission rates, and so adoption is likely to continue.

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“…Some authors suggested that no differences exist in terms of complication rate between outpatient TKAs and inpatient TKAs. The retrospective studies of Darrith et al [25] on 92 patients (46 outpatients), Cassard et al [24] on 574 patients (61 outpatients), Springer et al [29] on 166 patients (92 outpatients), and Gillis et al [27] on 400 patients (125 outpatients), as well as the prospective comparative cohort study of Gauthier-Kwan et al [26] on 43 outpatients vs 43 inpatients TKAs, reported comparable complication and readmission rates. A comparable readmission rate was also reported by Kimball et al [30] in a retrospective study analyzing 1726 patients (863 outpatients).…”

Section: Discussionmentioning

confidence: 92%

“…Eleven of these studies were excluded after full-text reading for the following reasons: 2 studies had results non-separated from other joints; 7 studies had data coming from the same database of other articles and included a lower number of patients; 1 study reported complications and readmission as odds ratio, 1 study reported data as percentage of subgroups making the results inaccurate for the analysis [22]. For this reasons, only 8 articles were included in the meta-analysis [23][24][25][26][27][28][29][30] (Fig. 1).…”

Section: Review Statisticsmentioning

confidence: 99%

Outpatient total knee arthroplasty leads to a higher number of complications: a meta-analysis

Bordoni¹,

Poggi²,

Zaffagnini³

et al. 2020

J Orthop Surg Res

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Background Careful pre- and post-operative management can allow surgeons to perform outpatient TKA, making this a more affordable procedure. The aim of the present meta-analysis is to compare outpatient and inpatient TKA. Methods A systematic search of the literature was performed in July 2020 on PubMed, Web of Science, Cochrane library, and on the grey literature databases. The papers collected were used for a meta-analysis comparing outpatient and inpatient TKA in terms of complication and readmission rates. Risk of bias and quality of evidence were defined according to Cochrane guidelines. Results The literature search resulted in 4107 articles; of these, 8 articles were used for the meta-analysis. A total of 212,632 patients were included, 6607 of whom were TKA outpatients. The overall complication rate for outpatient TKAs was 16.1%, while inpatient TKAs had an overall lower complication rate of 10.5% (p = 0.003). The readmission rate was 4.9% in outpatient TKAs and 5.9% in inpatient TKAs. Only 3 studies reported the number of deaths, which accounted for 0%. The included studies presented a moderate risk of bias, and according to GRADE guidelines, the level of evidence for complications and readmissions was very low. Conclusions This meta-analysis documented that outpatient TKA led to an increased number of complications although there were no differences in the number of readmissions. However, future high-level studies are needed to confirm results and indications for the outpatient approach, since the studies currently available have a moderate risk of bias and a very low quality of evidence.

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Inpatient Versus Outpatient Arthroplasty: A Single-Surgeon, Matched Cohort Analysis of 90-Day Complications

Cited by 84 publications

References 28 publications

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

An Examination of the Adoption of Outpatient Total Knee Arthroplasty Since 2018

Outpatient total knee arthroplasty leads to a higher number of complications: a meta-analysis

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