A study of nearly two million joint replacements over an eight-year period found no significantly higher complications in total hip replacements performed in outpatient settings as compared to inpatient procedures. The study of 1.8 million patients treated between 2010 and 2017 by surgeons at the Hospital for Special Surgery (HSS) appeared in the November 2021 edition of The Journal of Arthroplasty. The authors sought to compare complication rates between patients who went home hours after their procedures versus those who spent a night or two in the hospital.
The patients, discovered in the PearlDiver Mariner Database, were divided into groups based on which surgery they had and whether it was performed on an inpatient or outpatient basis. Researchers collected data on patient demographics, comorbidities and complications within 90 days of surgery that required readmission to the hospital.
The researchers found that outpatient total hips increased by 11% from 2010 to 2017. The same-day patients were younger and healthier overall, with fewer medical conditions such as diabetes and chronic pulmonary disease. No significant difference in complications requiring readmission to the hospital within 90 days was found between inpatient and outpatient procedures.
Geoffrey Westrich, MD, one of the study’s authors, says same-day-discharge joint replacement is safe with appropriate patient selection and additional early post-op monitoring. Patients with heart or lung disease, diabetes or sleep apnea are not good outpatient candidates, nor are smokers or people in their mid-70s or older, he says.
He notes that the migration of TJAs from inpatient to outpatient settings will continue to accelerate because payment bundles from the Centers for Medicare & Medicaid Services (CMS) now incentivize the reduction of nonessential hospital-associated costs and lengths of stays.
“Our study aimed to augment the literature on outpatient joint replacement surgery to help orthopedic surgeons and their patients make an informed decision,” says Dr. Westrich. “Although we found it can be performed safely and efficiently, it’s an option, not a requirement. Every patient is different, and individuals and their doctors should make an informed decision based on what makes patients feel most comfortable.” OSM