Skip to main content

Advertisement

SpringerLink
Log in

Defining growth potential and barriers to same day discharge total knee arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Outpatient arthroplasty programs are becoming well established. Adverse event rates have been demonstrated to be no worse than inpatient arthroplasty in the literature for selected patients. The purpose of this study was to determine our rate of outpatient total knee arthroplasty (TKA), examine justification for exclusions, and estimate the proportion of TKAs that can occur safely on an outpatient basis.

Methods

Retrospective case series of 400 consecutive TKAs from Oct 2014 to Mar 2017. Patient demographics, allocation to outpatient surgery vs standard admission, and reason for exclusion from outpatient surgery were recorded. Ninety-day Emergency department (ED) visits, readmission rates, and length of stay (LOS) were compared between groups using independent sample t test and Chi-squared test.

Results

Outpatients were younger (p = 0.001), had lower BMI (p < 0.001), and ASA scores (p < 0.001) than inpatients. One hundred twenty-five (31%) TKAs were assigned to outpatient surgery and 123 achieved discharge on the same day. There was no difference in 90-day ED visits (p = 0.889) or readmission rates (p = 0.338) between groups. Reasons for exclusion from outpatient surgery included medical (absolute 43% and relative 31%), distance > one hour from hospital (18%), no help (7%), and other/unclear (10%). LOS was significantly longer for medical than non-medical exclusions (p < 0.001) and for the absolute compared to relative medical exclusions (p = 0.004).

Conclusion

Outpatient TKA is safe in selected patients, and inclusion can likely be broadened by addressing modifiable exclusions and narrowing medical exclusions. We found that 55% of our TKA population could be appropriate for outpatient surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Berger RA, Sanders S, Gerlinger T, Della Valle C, Jacobs JJ, Rosenberg AG (2005) Outpatient total knee arthroplasty with a minimally invasive technique. J Arthroplast 20:33–38

    Article  Google Scholar 

  2. Berger RA, Kusuma SK, Sanders SA, Thill ES, Sporer SM (2009) The feasibility and perioperative complications of outpatient knee arthroplasty. Clin Orthop Relat Res 467(6):1443–1449. https://doi.org/10.1007/s11999-009-0736-7

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lovald ST, Ong KL, Malkani AL, Lau EC, Schmier JK, Kurtz SM, Manley MT (2014) Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplast 29(3):510–515

    Article  Google Scholar 

  4. Huang A, Ryu J-J, Dervin G (2017) Cost savings of outpatient versus standard inpatient total knee arthroplasty. Can J Surg 60(1):57

    PubMed  PubMed Central  Google Scholar 

  5. Dorr LD, Thomas DJ, Zhu J, Dastane M, Chao L, Long WT (2010) Outpatient total hip arthroplasty. J Arthroplast 25(4):501–506. https://doi.org/10.1016/j.arth.2009.06.005

    Article  Google Scholar 

  6. Meneghini RM, Ziemba-Davis M, Ishmael MK, Kuzma AL, Caccavallo P (2017) Safe selection of outpatient joint arthroplasty patients with medical risk stratification: the “outpatient arthroplasty risk assessment score”. J Arthroplast 32(8):2325–2331

  7. O'Reilly M, Mohamed K, Foy D, Sheehan E (2018) Educational impact of joint replacement school for patients undergoing total hip and knee arthroplasty: a prospective cohort study. Int Orthop. https://doi.org/10.1007/s00264-018-4039-z

  8. Bovonratwet P, Ondeck NT, Nelson SJ, Cui JJ, Webb ML, Grauer JN (2017) Comparison of outpatient vs inpatient total knee arthroplasty: an ACS-NSQIP analysis. J Arthroplast 32(6):1773–1778

    Article  Google Scholar 

  9. Lovecchio F, Alvi H, Sahota S, Beal M, Manning D (2016) Is outpatient arthroplasty as safe as fast-track inpatient arthroplasty? A propensity score matched analysis. J Arthroplast 31(9):197–201

    Article  Google Scholar 

  10. Otero JE, Gholson JJ, Pugely AJ, Gao Y, Bedard NA, Callaghan JJ (2016) Length of hospitalization after joint arthroplasty: does early discharge affect complications and readmission rates? J Arthroplast 31(12):2714–2725

    Article  Google Scholar 

  11. Den Hartog Y, Mathijssen N, Hannink G, Vehmeijer S (2015) Which patient characteristics influence length of hospital stay after primary total hip arthroplasty in a ‘fast-track’setting? Bone Joint J 97(1):19–23

    Article  Google Scholar 

  12. Kolisek FR, McGrath MS, Jessup NM, Monesmith EA, Mont MA (2009) Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res 467(6):1438–1442

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gauthier-Kwan OY, Dobransky JS, Dervin GF (2018) Quality of recovery, Postdischarge hospital utilization, and 2-year functional outcomes after an outpatient Total knee arthroplasty program. J Arthroplast 33(7):2159–2164.e2151. https://doi.org/10.1016/j.arth.2018.01.058

    Article  Google Scholar 

  14. Argenson J-NA, Husted H, Lombardi A Jr, Booth RE, Thienpont E (2016) Global forum: an international perspective on outpatient surgical procedures for adult hip and knee reconstruction. JBJS 98(13):e55

    Article  Google Scholar 

  15. Courtney PM, Boniello AJ, Berger RA (2017) Complications following outpatient total joint arthroplasty: an analysis of a national database. J Arthroplast 32(5):1426–1430

    Article  Google Scholar 

  16. Su EP, Perna M, Boettner F, Mayman DJ, Gerlinger T, Barsoum W, Randolph J, Lee G (2012) A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. J Bone Joint Surg Br 94(11 Suppl a):153–156. https://doi.org/10.1302/0301-620x.94b11.30832

    Article  CAS  PubMed  Google Scholar 

  17. Song MH, Kim BH, Ahn SJ, Yoo SH, Kang SW, Kim YJ, Kim DH (2016) Peri-articular injections of local anaesthesia can replace patient-controlled analgesia after total knee arthroplasty: a randomised controlled study. Int Orthop 40(2):295–299. https://doi.org/10.1007/s00264-015-2940-2

    Article  PubMed  Google Scholar 

  18. Li D, Yang Z, Xie X, Zhao J, Kang P (2016) Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis. Int Orthop 40(5):925–933. https://doi.org/10.1007/s00264-015-2998-x

    Article  PubMed  Google Scholar 

  19. Li Z, Cheng W, Sun L, Yao Y, Cao Q, Ye S, Qi L, Xu S, Wu X, Jing J (2018) Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study. Int Orthop 42(3):543–549. https://doi.org/10.1007/s00264-017-3703-z

    Article  PubMed  Google Scholar 

  20. Courtney PM, Melnic CM, Gutsche J, Hume EL, Lee GC (2015) Which patients need critical care intervention after total joint arthroplasty? : A prospective study of factors associated with the need for intensive care following surgery. Bone Joint J 97-B(11):1512–1518. https://doi.org/10.1302/0301-620X.97B11.35813

    Article  CAS  PubMed  Google Scholar 

  21. Sutton JC III, Antoniou J, Epure LM, Huk OL, Zukor DJ, Bergeron SG (2016) Hospital discharge within 2 days following total hip or knee arthroplasty does not increase major-complication and readmission rates. JBJS 98(17):1419–1428

    Article  Google Scholar 

  22. Pulido L, Parvizi J, Macgibeny M, Sharkey PF, Purtill JJ, Rothman RH, Hozack WJ (2008) In hospital complications after total joint arthroplasty. J Arthroplast 23(6):139–145

    Article  Google Scholar 

  23. Edelstein AI, Kwasny MJ, Suleiman LI, Khakhkhar RH, Moore MA, Beal MD, Manning DW (2015) Can the American College of Surgeons risk calculator predict 30-day complications after knee and hip arthroplasty? J Arthroplast 30(9):5–10

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgey, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Megan E. Gillis, Johanna Dobransky & Geoffrey F. Dervin

  2. The Ottawa Hospital, General Campus, University of Ottawa Division of Orthopedic Surgery, Suite W1645, Box 502, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Geoffrey F. Dervin

Authors
  1. Megan E. Gillis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johanna Dobransky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Geoffrey F. Dervin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geoffrey F. Dervin.

Ethics declarations

This study was reviewed and approved by the institutional ethics committee and the authors have no conflicts of interest to disclose.

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gillis, M.E., Dobransky, J. & Dervin, G.F. Defining growth potential and barriers to same day discharge total knee arthroplasty. International Orthopaedics (SICOT) 43, 1387–1393 (2019). https://doi.org/10.1007/s00264-018-4100-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-4100-y

Keywords

Search

Navigation