Outpatient Total Knee Arthroplasty Is Associated with Higher Risk of Perioperative Complications

Abstract

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Inpatient versus Outpatient Total Knee Arthroplasty

“…Patients were also found to be at risk of an increase in deep vein thrombosis in the first 60 days after surgery (OR ¼ 1.42), as well as an increase in acute renal failure in the first 14 days after surgery (OR ¼ 1.13). 24 Other recent studies have also suggested a slight, but clinically significant increase in blood transfusions in the OP cohort. 21,22 Lovecchio et al report similar rates of transfusion after surgery but higher rates of transfusion postdischarge in OPs (anytime, 7.5% OPs vs. 5.6% IPs, p ¼ 0.113; postdischarge, 4.1% OPs vs. 0.1% IPs, p < 0.001).…”

“…Arshi et al recently demonstrated a higher risk of perioperative and medical complications inpatients who underwent OP versus IP TKA. 24 Using a review of nationwide data from a private insurance database, the authors reported an increase in the 1-year risk of tibial and/or femoral component revision (odds ratio [OR] ¼ 1.22), explantation of the prosthesis (OR ¼ 1.35), irrigation and debridement (OR ¼ 1.50), and stiffness requiring manipulation under anesthesia (OR ¼ 1.28). Patients were also found to be at risk of an increase in deep vein thrombosis in the first 60 days after surgery (OR ¼ 1.42), as well as an increase in acute renal failure in the first 14 days after surgery (OR ¼ 1.13).…”

Risk Factors for Greater Than 24-Hour Length of Stay After Primary Total Knee Arthroplasty

“…Various studies report substantial reductions in LOS with an average LOS for TKA currently ranging from 2.97 to 5.4 days [2,4,6e8]. However, studies have raised concerns about increased risk of postoperative complications in patients undergoing outpatient TKA [9].…”

The Clinical and Financial Consequences of the Centers for Medicare and Medicaid Services’ Two-Midnight Rule in Total Joint Arthroplasty

“…In a separate study, the same authors found that observation admissions starting before 8:00 AM were significantly less likely to span 2 midnights compared to admissions occurring later in the day [22]. While LOS continues to decline for TJA procedures, there are a significant number of patients, particularly in the Medicare population, that are not appropriate for discharge before midnight on the day of surgery [23,24]. Whether due to known risk factors, patient preference, or simply due to the time of day that the procedure is performed, the TMR ignores this substantial population.…”