Reimbursement and Complications in Outpatient vs Inpatient Unicompartmental Arthroplasty

Abstract

unicompartmental knee arthroplasty outpatient inpatient reimbursement cost complications a b s t r a c tBackground: Increasing utilization of unicompartmental knee arthroplasty (UKA) has driven a greater push for outpatient treatment and cost containment in the setting of bundled payments. The purpose of this study is to evaluate utilization trends of inpatient vs outpatient UKA, index episode and 90-day reimbursement, and any differences in medical or surgical complications. Methods: The PearlDiver database was employed to identify all inpatient and outpatient UKAs performed between 2007 and 2016 with 2-year follow-up. Patients were matched by age, gender, and Elixhauser Comorbidity Index. We tracked index procedure and global period reimbursement, 90-day medical and surgical complications, and 2-year surgical complications. Results: The reimbursement and utilization cohort included 3181 outpatient and 5490 inpatient UKAs. Outpatient UKA and overall utilization of UKA increased over the study period. Mean index reimbursement of inpatient UKA was $2486.16 higher per procedure (P < .001) while mean global period reimbursement was $2782.13 higher per inpatient procedure (P < .001). Ninety-day medical complications including postoperative anemia (P < .001), transfusion (P ¼ .024), and arrhythmia (P ¼ .004) were more common with inpatient UKAs, whereas surgical wound complications (P ¼ .001) and operative debridement (P ¼ .028) were more common among outpatient UKAs. Outpatient UKA was not associated with an increased risk of periprosthetic joint infection (P > .05), aseptic loosening (P > .05), or revision surgery (P > .05) when compared to inpatient UKA. Conclusion: Outpatient UKA utilization is increasing and is associated with decreased reimbursement compared to inpatient UKA without increased risk of major medical complications, although it is associated with increased risk of wound complication and need for operative debridement at 90 days.

The association between surgical duration and venous thromboembolism in outpatient surgery: A propensity score adjusted prospective cohort study

“…Outpatient surgeries account for 60–70% of all surgical procedures [ 6 , 7 ]. In addition, more complex surgeries (e.g., total knee arthroplasty, thyroidectomy, hysterectomy) with greater risks of VTEs are currently being performed in ambulatory facilities [ [8] , [9] , [10] ]. Increased surgical duration has been demonstrated to be an independent risk for the development of VTE after inpatient surgeries [ 11 ].…”

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

“…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].…”

“…A shorter LOS could effectively save the cost of hospitalization and reduce the risk of nosocomial infection [18]. Current studies have con rmed the safety and e cacy of outpatient UKA [7][9] [13]. Meanwhile, excellent anesthesia and intraoperative monitoring were necessary for ensuring the safety and e cacy of the operation.…”

“…In recent years, the improvement of surgical techniques and the development of Enhanced Recovery after Surgery (ERAS) management allowed UKA to be performed in a same-day, outpatient setting [5] [6]. Outpatient UKA has been widely performed and associated with decreased length of stay compared to inpatient procedure without increased risk of major complications [7] [8]. Outpatient joint arthroplasty could effectively reduce the LOS, and thus, minimize the incidence of nosocomial infection [9].…”

Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

“…12 The development of protocols for transitioning from outpatient to inpatient orthopedic procedures has seen tremendous success for various orthopedic procedures, such as total joint arthroplasty. [13][14][15][16][17][18] These studies have found ambulatory surgery to be safe and effective and may potentially result in a reduction of nosocomial complications when compared to inpatient procedures.…”