Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

Gabor, Jonathan A.; Singh, Vivek; Schwarzkopf, Ran; Davidovitch, Roy I.

doi:10.1016/j.artd.2020.05.008

Cited by 17 publications

(25 citation statements)

References 36 publications

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“…Regarding PROMs, we observed that patients undergoing fast-track THR in the study period experienced similar satisfaction and functional gains (Δ), as indicated by similar HOOS Jr and VR-12 scores from baseline scores. Our findings support previously published results of patients experiencing similar improvements in PROMs after early (e.g., ambulatory) discharge versus inpatient THR ( 27 , 28 ). Interestingly, in our study the preoperative PROMs trended towards being lower for the study cohort.…”

Section: Discussionsupporting

confidence: 92%

Reduction in hospital length of stay and increased utilization of telemedicine during the “return-to-normal” period of the COVID-19 pandemic does not adversely influence early clinical outcomes in patients undergoing total hip replacement: a case-control study

Sarpong

Kuyl

Ong

et al. 2022

ActaO

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Background and purpose: Elective total hip replacement (THR) was halted in our institution during the COVID-19 surge in March 2020. Afterwards, elective THR volume increased with emphasis on fast-track protocols, early discharge, and post-discharge virtual care. We compare early outcomes during this “return-to-normal period” with those of a matched pre-pandemic cohort.Patients and methods: We identified 757 patients undergoing THR from June to August 2020, who were matched 1:1 with a control cohort from June to August 2019. Length of stay (LOS) for the study cohort was lower than the control cohort (31 vs. 45 hours; p < 0.001). The time to first postoperative physical therapy (PT) was shorter in the study cohort (370 vs. 425 minutes; p < 0.001). More patients were discharged home in the study cohort (99% vs. 94%; p < 0.001). Study patients utilized telehealth office and rehabilitation services 14 times more frequently (39% vs. 2.8%; p < 0.001). Outcomes included post-discharge 90-day unscheduled office visits, emergency room (ER) visits, complications, readmissions, and PROMs (HOOS JR, and VR-12 mental/physical). Mann–Whitney U and chi-square tests were used for group comparisons.Results: Rates of 90-day unscheduled outpatient visits (5.0% vs. 7.3%), ER visits (5.0% vs. 4.8%), hospital readmissions (4.0% vs. 2.8%), complications (0.04% vs. 0.03%), and 3-month PROMs were similar between cohorts. There was no 90-day mortality.Interpretation: A reduction in LOS and increased telehealth use for office and rehabilitation visits did not adversely influence 90-day clinical outcomes and PROMs. Our findings lend further support for the utilization of fast-track arthroplasty with augmentation of postoperative care delivery using telemedicine.

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Section: Discussionsupporting

confidence: 92%

Reduction in hospital length of stay and increased utilization of telemedicine during the “return-to-normal” period of the COVID-19 pandemic does not adversely influence early clinical outcomes in patients undergoing total hip replacement: a case-control study

Sarpong

Kuyl

Ong

et al. 2022

ActaO

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“…Same day discharge arthroplasty is an established protocol which has been demonstrated to be safe with no significant increase in rates of complication or readmission, 24 - 27 nor has there been any decrease in patient reported outcomes. 28 There are evidence-based criteria to minimize the readmission and failures of SDS, and these were followed in the patient choices. 29 Assessments on cost-effectiveness and possible cost-reduction of day surgery procedures have also been favourable.…”

Section: Discussionmentioning

confidence: 99%

Converting hip and knee arthroplasty cases to same-day surgery due to COVID-19

et al. 2021

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Aims In 2020, the COVID-19 pandemic meant that proceeding with elective surgery was restricted to minimize exposure on wards. In order to maintain throughput of elective cases, our hospital (St Michaels Hospital, Toronto, Canada) was forced to convert as many cases as possible to same-day procedures rather than overnight admission. In this retrospective analysis, we review the cases performed as same-day arthroplasty surgeries compared to the same period in the previous 12 months. Methods We conducted a retrospective analysis of patients undergoing total hip and knee arthroplasties over a three-month period between October and December in 2019, and again in 2020, in the middle of the COVID-19 pandemic. Patient demographics, number of outpatient primary arthroplasty cases, length of stay for admissions, 30-day readmission, and complications were collated. Results In total, 428 patient charts were reviewed for October to December of 2019 (n = 195) and 2020 (n = 233). Of those, total hip arthroplasties (THAs) comprised 60% and 58.8% for 2019 and 2020, respectively. Demographic data was comparable with no statistical difference for age, sex, contralateral joint arthroplasty, or BMI. American Society of Anesthesiologists grade I was more highly prevalent in the 2020 cohort (5.1-times increase; n = 13 vs n = 1). Degenerative disc disease and fibromyalgia were less significantly prevalent in the 2020 cohort. There was a significant increase in same day discharges for non-direct anterior approach THAs (two-times increase) and total knee arthroplasty (ten-times increase), with a reciprocal decrease in next day discharges. There were significantly fewer reported superficial wound infections in 2020 (5.6% vs 1.7%) and no significant differences in readmissions or emergency department visits (3.1% vs 3.0%). Conclusion The COVID-19 pandemic meant that hospitals and patients were hopeful to minimize the exposure to the wards, and minimize strain on the already taxed inpatient beds. With few positives during the COVID-19 crisis, the pandemic was the catalyst to speed up the outpatient arthroplasty programme that has resulted in our institution being more efficient, and with no increase in readmissions or early complications. Cite this article: Bone Jt Open 2021;2(7):545–551.

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“…Concerning decreased pain for the studies investigating a THA population, VAS scores between studies displayed results that were conflicting, with two studies favouring the inpatient group [ 52 , 54 ] while two studies favoured the outpatient group[ 57 , 58 ]. Timepoints of these assessments also varied, the results favouring the inpatient group were taken at time points less than three months after surgery, whereas the results favouring the outpatient group were assessed on the day of discharge and at a two-year follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…Of those articles, 1,593 were removed as duplicates leaving 1829 to be reviewed at title and abstract level for eligibility. Following a second full-text screening of 55 articles, a final seven studies were included in this review [52][53][54][55][56][57][58]. The complete search and screening process is outlined in Fig.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

A comparison of functional outcomes following inpatient versus outpatient hip or knee arthroplasty

et al. 2022

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Background The length of hospital stay after lower limb arthroplasty has rapidly decreased in the last decade, largely in part due to the rise of improved perioperative protocols, but also as a response to the increased economic demand associated with the rapid growth in hip and knee arthroplasty procedures. In line with this, the development of a new pathway after lower limb arthroplasty that allows for the surgery to be performed in an outpatient setting and permits for same-day discharge after the procedure is increasingly being offered. Although costs and complications between the inpatient and outpatient models have been compared, there appears to be little known about the effects on a patient’s physical function after undergoing hip or knee outpatient arthroplasty. Therefore, this systematic review aims to explore the available evidence for the effect on functional outcomes following inpatient versus outpatient hip or knee arthroplasty. Methods This systematic review adhered to the PRISMA guidelines and was prospectively registered (https://osf.io/8bfae/). An electronic search of three online databases (PubMed, CINAHL and EMBASE) was conducted to identify eligible studies. All studies investigating inpatient and outpatient comparator groups, for a population of patients undergoing hip or knee arthroplasty, that assessed one or more functional outcomes, were included. A methodological quality appraisal was undertaken for the final studies contained in this review. A narrative synthesis of results is described along with quantitative outcomes presented in tables and figures. Results A total of seven studies containing 1,876 participants were included in this review. Four studies assessed a THA population, two assessed TKA and one assessed both. Functional outcomes varied, with 20 different functional outcomes utilised, of which 18 were patient-reported tools. Results of functional outcomes offered mixed support for both inpatient and outpatient pathways. Conclusions The results of this review suggest that outpatient or inpatient pathway selection for hip or knee arthroplasty should not be based on the superiority of functional outcomes alone. However, given there is growing evidence in support of an outpatient pathway in select patients with respect to cost savings and without any increase in complications, it could be proposed that an equivalency of post-operative function between the two settings makes same-day discharge favourable. Publicly registered with Open Science Framework (https://osf.io/8bfae/).

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Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

Cited by 17 publications

References 36 publications

Reduction in hospital length of stay and increased utilization of telemedicine during the “return-to-normal” period of the COVID-19 pandemic does not adversely influence early clinical outcomes in patients undergoing total hip replacement: a case-control study

Reduction in hospital length of stay and increased utilization of telemedicine during the “return-to-normal” period of the COVID-19 pandemic does not adversely influence early clinical outcomes in patients undergoing total hip replacement: a case-control study

Converting hip and knee arthroplasty cases to same-day surgery due to COVID-19

A comparison of functional outcomes following inpatient versus outpatient hip or knee arthroplasty

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