Is Outpatient Unicompartmental Knee Arthroplasty Safe to Perform at an Ambulatory Surgery Center? A Comparative Study of Early Post-Operative Complications

Cody, John P.; Pfefferle, Kiel J.; Ammeen, Deborah J.; Fricka, Kevin B.

doi:10.1016/j.arth.2017.10.007

Cited by 38 publications

(21 citation statements)

References 16 publications

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“…The safety of initiating an outpatient TJA program at a freestanding ASC has been published previously in a limited fashion [4] , [6] , [17] , [18] . The safety of major surgery in ambulatory surgery centers has been questioned in mainstream media [20] .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the definition of outpatient TJA in some studies has included overnight stay of under 23 hours [16] . Although there are potential benefits associated with TJA at an ambulatory surgical center (ASC), potential complications and safety of outpatient TJA at a standalone ASC continue to be quantified and demonstrate promising outcomes with complication rates ≤7% [2] , [17] , [18] , [19] . However, safety of major surgeries at ASCs continues to be questioned in mainstream media [20] .…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Compared to total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) is associated with an earlier recovery, less postoperative pain, lower morbidity and mortality, and a greater "feel" of a normal knee, which made UKA a better surgical option for patients with end-stage medial compartment osteoarthritis [15] [16]. Because of not increasing postoperative complications and risk of re-admission, outpatient joint arthroplasty have been widely performed in recent years [17].…”

Section: Discussionmentioning

confidence: 99%

Spinal Versus General Anesthesia for the Outpatient Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial

Chen¹,

Yin²,

Xu³

et al. 2020

Preprint

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Purpose: To compare the early clinical outcomes between anesthetic techniques in outpatient unicompartmental knee arthroplasty (UKA) and investigate factors responsible for delayed discharge. Method: A randomized controlled trial was conducted on 64 consecutive and unselected patients who underwent primary, medial UKA and randomly divided into two groups:32 patients with spinal anaesthesia(Group A) and 32 with general anaesthesia(Group B). There were no significant differences in gender, age, body mass index (BMI), the hospital for Special Surgery knee score (HSS), and American Society of Anesthesiology(ASA) class between the two groups (P >0.05).Results：Totally 64 patients were involved, including 20 males and 42 females, with an average age of 60.4 ± 3.8 year-old. The length of stay(LOS) and total expense were significantly less in group A than those in group B (P < 0.05). There was no significant difference between two groups on the discharge day and the reasons for not discharge(P>0.05). Lack of mobilization (84%), pain (23%), and PONV (17%) were main reasons for patients not meeting the discharge criteria on DOS (Table 2). Patients with spinal anaesthesia underwent a longer surgery time than those with GA.(P<0.05); Patients in the Group A had a significantly earlier oral fluid intake and walking unaided(P<0.05); Pain occurred significantly earlier in Group B(P<0.05). Conclusion: In patients who underwent outpatient UKA, spinal anaesthesia is significantly superior to general anaesthesia with shorter discharge time and lower cost. With strict patient selection and safe anaesthesia, outpatient UKA could attain a good clinical outcome with both anaesthesia techniques.

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“…8 Previous studies comparing outcomes of inpatient and outpatient settings for other orthopaedic surgeries, including treatment of distal radius fractures, treatment of ankle fractures, knee arthroplasty, hip arthroplasty, shoulder arthroplasty, and anterior cervical discectomy and fusion, have shown similar or decreased rates of major and total complications as well as significant cost savings. [8][9][10][11][12][13][14][15][16][17] A study on the economic burden of inpatient admission for ankle fractures by Stull et al 17 found that performing cases in the outpatient setting would represent an annual cost savings of 35.5% to the health care system, a savings of more than US$280 million. Similarly, a study by Richter and Diduch 13 demonstrated a cost savings of up to 50% with outpatient compared with inpatient unicompartmental knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

A Safety and Cost Analysis of Outpatient Versus Inpatient Hindfoot Fusion Surgery

Moon

McGee

Patel

et al. 2018

Foot & Ankle Specialist

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Background. Hindfoot fusion procedures are increasingly being performed in the outpatient setting. However, the cost savings of these procedures compared with the risks and benefits has not been clearly investigated. The objective of this study was to compare patient characteristics, costs, and short-term complications between inpatient and outpatient procedures. Methods. This was a retrospective review of all patients who underwent inpatient and outpatient hindfoot fusion procedures by a single surgeon, at 1 academic institution, from 2013 to 2017. Data collected included demographics, operative variables, comorbidities, complications, costs, and subsequent reencounters. Results. Of 124 procedures, 34 were inpatient and 90 were outpatient. Between procedural settings, with the numbers available, there was no significant increase in complication rate or frequency of reencounters within 90 days. There were no significant differences in the number of patients with reencounters related to the index procedure within 90 days (P = .43). There were 30 reencounters within 90 days after outpatient surgery versus 4 after inpatient surgery (P = .05). The total number of emergency room visits in the outpatient group within 90 days was significantly higher compared with the inpatient group (P = .04). The average cost for outpatient procedures was US$4159 less than inpatient procedures (P < .0001). Conclusion. Outpatient hindfoot fusion may be a safe alternative to inpatient surgery, with significant overall cost savings and similar rate of short-term complications. On the basis of these findings, we believe that outpatient management is preferable for the majority of patients, but further investigation is warranted. Levels of Evidence: Level III

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Is Outpatient Unicompartmental Knee Arthroplasty Safe to Perform at an Ambulatory Surgery Center? A Comparative Study of Early Post-Operative Complications

Cited by 38 publications

References 16 publications

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

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

Spinal Versus General Anesthesia for the Outpatient Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial

A Safety and Cost Analysis of Outpatient Versus Inpatient Hindfoot Fusion Surgery

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