The Feasibility and Perioperative Complications of Outpatient Knee Arthroplasty

Abstract

The duration of hospitalization and subsequent length of recovery after elective knee arthroplasty have decreased. We hypothesized same-day discharge following either a unicompartmental (UKA) or total knee arthroplasty (TKA) in an unselected group of patients would not result in a higher perioperative complication rate than standardlength hospitalization when following a comprehensive perioperative clinical pathway, including preoperative teaching, regional anesthesia, preemptive oral analgesia, preemptive antiemetics, and a rapid rehabilitation protocol. We prospectively followed 111 of all 121 patients who had primary knee arthroplasty completed by noon and who agreed to be followed prospectively; 25 had UKA and 86 TKA. Of the 111 patients, 104 (94%, 24 with UKA and 80 with TKA) met discharge criteria and were discharged directly to home the day of surgery. Nausea requiring additional treatment before discharge was the most common reason for a delay in discharge. There were four (3.6%) readmissions (all with TKA) and one emergency room visit without readmission (in a patient with a TKA) within the first week after surgery, while there were four subsequent readmissions (3.6%) and one additional emergency room visit without readmission within three months of surgery, all among patients undergoing TKA. There were no deaths, cardiac events, or pulmonary complications during this study. Outpatient knee arthroplasty surgery is feasible in a large percentage of patients yet early readmissions may be decreased with a prolonged hospitalization.

Total hip arthroplasty in an outpatient setting in 27 selected patients

“…In the USA, THA in an outpatient setting for selected patients has already been described (Berger et al 2009a, Aynardi et al 2014). Moreover, US centers have also reported on hemi- and total knee replacement in an outpatient setting (Berger et al 2009b, Cross and Berger 2014). Although this trend in the USA could well be patient cost-driven, as some patients have to pay extra for each night that they stay in hospital, there does appear to be a general trend towards outpatient joint replacement.…”

Definitional Differences of ‘Outpatient’ Versus ‘Inpatient’ THA and TKA Can Affect Study Outcomes

“…There has been a recent surge of interest in performing THA and TKA in the outpatient setting [3,4,9]. The benefits of outpatient arthroplasty are reported to include higher patient satisfaction and reduced costs [15,29].…”

“…This ''observation'' status obscures the division between what is considered inpatient or outpatient. Some studies on outpatient arthroplasty have defined ''outpatient'' status as patients who were discharged the same day [5,9,10], patients who stayed at most one night at the hospital [2,4,24], patients who stayed at most two nights at the hospital [15,25], or simply provided stated status with no quantitative description [16,29,40].…”

Outpatient Total Joint Arthroplasty

“…In their retrospective study of 110 patients who underwent OTJA at a center accustomed to rapid rehab protocols and minimally invasive techniques, Berger et al found that inadequate pain control and completing surgery late in the day were most strongly associated with preventing same-day discharge [10]. They found no differences in BMI, average age, body weight, or medical comorbidities between patients who underwent OTJA and those who required inpatient stay [13]. They also found that for patients undergoing TKA, compared to UKA, history of myocardial infarction within 1 year, BMI > 40, and greater than three medical comorbidities were most strongly associated with increased risk of readmission [14].…”