Defining growth potential and barriers to same day discharge total knee arthroplasty
- 124 Downloads
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.
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.
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).
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.
KeywordsSame day discharge Total knee arthroplasty Outpatient Inpatient Exclusions
Compliance with ethical standards
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.
- 4.Huang A, Ryu J-J, Dervin G (2017) Cost savings of outpatient versus standard inpatient total knee arthroplasty. Can J Surg 60(1):57Google 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):2325–2331Google Scholar
- 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
- 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 CrossRefGoogle 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 CrossRefGoogle 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 CrossRefGoogle Scholar