1
|
de Ladoucette A, Godet J, Resurg, Jenny JY, Ramos-Pascual S, Kumble A, Muller JH, Saffarini M, Biette G, Boisrenoult P, Brochard D, Brosset T, Cariven P, Chouteau J, Henry MP, Hulet C. Complication rates are not higher after outpatient compared to inpatient fast-track total hip arthroplasty: a propensity-matched prospective comparative study. Hip Int 2024:11207000241267977. [PMID: 39189627 DOI: 10.1177/11207000241267977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
PURPOSE Concerns remain with regards to safety of fast-track (FT) and especially outpatient procedures. The purpose of this study was to compare complication rates and clinical outcomes of propensity-matched patients who received FT total hip arthroplasty (THA) in outpatient versus inpatient settings. The hypothesis was that 90-day postoperative complication rates of outpatient FT THA would not be higher than after inpatient FT THA. METHODS This is a prospective study of consecutive patients who received FT THA at various rates of outpatient and inpatient surgery by 10 senior surgeons (10 centres). The decision between outpatient and inpatient surgery was made on a case-by-case basis depending on the surgeon and patient. All patients were followed until 90 days after surgery. Complications, readmissions and reoperations were collected, and their severity was assessed according to Clavien-Dindo. Patients completed Oxford Hip Score (OHS) at the latest follow-up. RESULTS Compared to inpatient FT THA, patients scheduled for outpatient FT THA had no significant differences in 90-day postoperative complication rates (10.7% vs. 12.9%, p = 0.129). There were no significant differences between the 2 groups in 90-day readmission rates and reoperation rates, in severity of postoperative complications, and in time of occurrence of postoperative complications. CONCLUSIONS There were no differences in rates of intraoperative complications, 90-day postoperative complications, readmissions, or reoperations between outpatient and inpatient FT THA. These findings may help hesitant surgeons to move towards outpatient THA pathways as there is no greater risk of early postoperative complications that could be more difficult to manage after discharge.
Collapse
Affiliation(s)
| | - Julien Godet
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Resurg
- ReSurg SA, Nyon, Switzerland
| | | | | | | | | | | | | | - Philippe Boisrenoult
- Centre Hospitalier de Versailles - Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | | | - Thomas Brosset
- Cité Santé Plus, Alpilles Luberon Orthopédie, Cavaillon, France
| | | | | | | | | |
Collapse
|
2
|
Prentice HA, Harris JE, Sucher K, Fasig BH, Navarro RA, Okike KM, Maletis GB, Guppy KH, Chang RW, Kelly MP, Hinman AD, Paxton EW. Improvements in Quality, Safety and Costs Associated with Use of Implant Registries Within a Health System. Jt Comm J Qual Patient Saf 2024; 50:404-415. [PMID: 38368191 DOI: 10.1016/j.jcjq.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Clinical quality registries (CQRs) are intended to enhance quality, safety, and cost reduction using real-world data for a self-improving health system. Starting in 2001, Kaiser Permanente established several medical device CQRs as a quality improvement initiative. This report examines the contributions of these CQRs on improvement in health outcomes, changes in clinical practice, and cost-effectiveness over the past 20 years. METHODS Eight implant registries were instituted with standardized collection from the electronic health record and other institutional data sources of patient characteristics, medical comorbidities, implant attributes, procedure details, surgical techniques, and outcomes (including complications, revisions, reoperations, hospital readmissions, and other utilization measures). A rigorous quality control system is in place to improve and maintain the quality of data. Data from the Implant Registries form the basis for multiple quality improvement and patient safety initiatives to minimize variation in care, promote clinical best practices, facilitate recalls, perform benchmarking, identify patients at risk, and construct reports about individual surgeons. RESULTS Following the inception of the Implant Registries, there was an observed (1) reduction in opioid utilization following orthopedic procedures, (2) reduction in use of bone morphogenic protein during lumbar fusion allowing for cost savings, (3) reduction in allograft for anterior cruciate ligament reconstruction and subsequent decrease in organizationwide revision rates, (4) cost savings through expansion of same-day discharge programs for joint arthroplasty, (5) increase in the use of cement fixation in the hemiarthroplasty treatment of hip fracture, and (6) organizationwide discontinuation of an endograft device associated with a higher risk for adverse outcomes following endovascular aortic aneurysm repair. CONCLUSION The use of Implant Registries within our health system, along with clinical leadership and organizational commitment to a learning health system, was associated with improved quality and safety outcomes and reduced costs. The exact mechanisms by which such registries affect health outcomes and costs require further study.
Collapse
|
3
|
LaValva SM, Bovonratwet P, Chen AZ, Lebrun DG, Davie RA, Shen TS, Su EP, Ast MP. Frequency and Timing of Postoperative Complications After Outpatient Total Hip Arthroplasty. Arthroplast Today 2024; 27:101420. [PMID: 38966329 PMCID: PMC11222924 DOI: 10.1016/j.artd.2024.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/14/2024] [Accepted: 04/28/2024] [Indexed: 07/06/2024] Open
Abstract
Background Although there have been several studies describing risk factors for complications after outpatient total hip arthroplasty (THA), data describing the timing of such complications is lacking. Methods Patients who underwent outpatient or inpatient primary THA were identified in the 2012-2019 National Surgical Quality Improvement Program database. For 9 different 30-day complications, the median postoperative day of diagnosis was determined. Multivariable regressions were used to compare the risk of each complication between outpatient vs inpatient groups. Multivariable Cox proportional hazards modeling was used to evaluate the differences in the timing of each adverse event between the groups. Results After outpatient THA, the median day of diagnosis for readmission was 12.5 (interquartile range 5-22), surgical site infection 15 (2-21), urinary tract infection 13.5 (6-19.5), deep vein thrombosis 13 (8-21), myocardial infarction 4.5 (1-7), pulmonary embolism 15 (8-25), sepsis 16 (9-26), stroke 2 (0-7), and pneumonia 6.5 (3-10). On multivariable regressions, outpatients had a lower relative risk (RR) of readmission (RR = 0.73), surgical site infection (RR = 0.72), and pneumonia (RR = 0.1), all P < .05. On multivariable cox proportional hazards modeling, there were no statistically significant differences in the timing of each complication between outpatient vs inpatient procedures (P > .05). Conclusions The timing of complications after outpatient THA was similar to inpatient procedures. Consideration should be given to lowering thresholds for diagnostic testing after outpatient THA for each complication during the at-risk time periods identified here. Although extremely rare, this is especially important for catastrophic adverse events, which tend to occur early after discharge.
Collapse
Affiliation(s)
- Scott M. LaValva
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Patawut Bovonratwet
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Aaron Z. Chen
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Drake G. Lebrun
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Ryann A. Davie
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Tony S. Shen
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Edwin P. Su
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Michael P. Ast
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
4
|
Singh V, Jayne CS, Cuero KJ, Thomas J, Rozell JC, Schwarzkopf R, Macaulay W, Davidovitch RI. Are We Moving in the Right Direction? Demographic and Outcome Trends in Same-day Total Hip Arthroplasty From 2015 to 2020. J Am Acad Orthop Surg 2024; 32:346-353. [PMID: 38194641 DOI: 10.5435/jaaos-d-23-00762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Understanding the trends among patients undergoing same-day discharge (SDD) total hip arthroplasty (THA) is imperative to highlight the progression of outpatient surgery and the criteria used for enrollment. The purpose of this study was to identify trends in demographic characteristics and outcomes among patients who participated in an academic hospital SDD THA program over 6 years. METHODS We retrospectively reviewed all patients who enrolled in our institution's SDD THA program from January 2015 to October 2020. Patient demographics, failure-to-launch rate, as well as readmission and revision rates were evaluated. Trends for continuous variables were analyzed using analysis of variance, and categorical variables were analyzed using chi-square tests. RESULTS In total, 1,334 patients participated in our SDD THA program between 2015 and 2020. Age (54.82 to 57.94 years; P < 0.001) and mean Charlson Comorbidity Index (2.15 to 2.90; P < 0.001) significantly differed over the 6-year period. More African Americans (4.3 to 12.3%; P = 0.003) and American Society of Anesthesiology class III (3.2% to 5.8%; P < 0.001) patients enrolled in the program over time. Sex ( P = 0.069), BMI ( P = 0.081), marital status ( P = 0.069), and smoking status ( P = 0.186) did not statistically differ. Although the failure-to-launch rate (0.0% to 12.0%; P < 0.001) increased over time, the 90-day readmissions ( P = 0.204) and 90-day revisions ( P = 0.110) did not statistically differ. CONCLUSION More African Americans, older aged individuals, and patients with higher preexisting comorbidity burden enrolled in the program over this period. Our findings are a reflection of a more inclusive selection criterion for participation in the SDD THA program. These results highlight the potential increase in the number of patients and surgeons interested in SDD THA, which is paramount in the current incentivized and value-based healthcare environment. LEVEL EVIDENCE III, Retrospective Review.
Collapse
Affiliation(s)
- Vivek Singh
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Singh, Mr. Thomas, Dr. Rozell, Dr. Schwarzkopf, Dr. Macaulay, and Dr. Davidovitch), and the Department of Orthopaedic Surgery, Dignity Health St. Joseph's Medical Center, Stockton, CA (Dr. Singh, Dr. Jayne, and Dr. Cuero)
| | | | | | | | | | | | | | | |
Collapse
|
5
|
White J. Ambulatory Surgery Total Joint Arthroplasty: The Transition of an Inpatient Orthopedic Nursing Unit. HSS J 2024; 20:48-50. [PMID: 38356739 PMCID: PMC10863585 DOI: 10.1177/15563316231210869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Jake White
- Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
6
|
Foissey C, Pineda T, Servien E, Fontalis A, Batailler C, Lustig S. Adapting hip arthroplasty practices during the COVID-19 pandemic: Assessing the impact of outpatient care sudden increase on early complications and clinical outcomes. SICOT J 2024; 10:1. [PMID: 38193980 PMCID: PMC10775906 DOI: 10.1051/sicotj/2023037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has significantly affected access to timely care for patients with hip osteoarthritis requiring total hip replacement (THR). This study aimed to assess the changes in surgical activity, outpatient treatment, length of stay (LOS), discharge destinations, readmission rates, clinical outcomes, and patient satisfaction before and after the pandemic at our institution. MATERIALS AND METHODS This retrospective study encompassed patients undergoing primary THR through the direct anterior approach at a single university hospital. Data on demographic characteristics, surgical technique, perioperative management, LOS, discharge destinations, complications, and clinical outcomes were collected. Furthermore, a comparative analysis between the pre-pandemic (2019) and post-pandemic (2022) periods was conducted. RESULTS There was a 14% increase in surgical activity post-pandemic, with 214 patients undergoing surgery in 2019 versus 284 in 2022. The percentage of patients managed as outpatients significantly increased from 0.5% in 2019 to 29.6% in 2022 (p < 0.001). LOS decreased from 2.7 ± 1 [0-8] days to 1.4 ± 1.1 [0-12] days (p < 0.001), and the rate of discharge to rehabilitation centres declined from 21.5% to 8.8% (p < 0.001). No significant increase in the readmission rates was observed (1.4% in both periods). At two months postoperatively, the mean HHS and satisfaction rates were comparable between the two groups (p = 1 and p = 0.73, respectively). DISCUSSION Despite the challenges posed by the COVID-19 pandemic, surgical activity at our institution demonstrated an increase compared to the pre-pandemic levels by expanding outpatient care, reducing LOS, and increasing rates of home discharges. Importantly, these changes did not adversely affect rehospitalization rates or early clinical outcomes. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Constant Foissey
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Tomas Pineda
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
- LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility Claude Bernard Lyon 1 University Lyon France
| | - Andreas Fontalis
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust 235 Euston Rd. London NW1 2BU UK
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
- Division of Surgery and Interventional Science, University College London Gower Street London WC1E 6BT UK
| |
Collapse
|
7
|
Gordon AM, Ng MK, Schwartz J, Wong CHJ, Erez O, Mont MA. Inconsistent Classification of "Outpatient" Surgeries Leads to Different Outcomes Following Total Hip Arthroplasty in Medicare Beneficiaries: A Critical Analysis. J Arthroplasty 2024; 39:19-25. [PMID: 37634876 DOI: 10.1016/j.arth.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND With rising utilization of outpatient total hip arthroplasty (THA) in older patients including Medicare beneficiaries, the objective was to compare differences in definition including (1) patient demographics; (2) lengths of stay (LOS); and (3) outcomes of "outpatient" (stated status) versus "same-day discharge" (SDD) (actual LOS = 0 days) utilizing a nationwide database. METHODS A national database from 2015 to 2019 was queried for Medicare-aged patients undergoing outpatient THA. Total outpatient THAs (N = 6,072) were defined in one of 2 ways: either "outpatient" by the hospital (N = 2,003) or LOS = 0 days (N = 4,069). Demographics, LOS, discharge destinations, and complications were compared between groups. Logistic regression models computed odds ratios (ORs) for factors leading to complications, readmissions, and nonhome discharges. P values < .008 were significant. RESULTS Women (OR: 1.19, P = .002), diabetes mellitus (OR: 1.31, P = .003), general anesthesia (OR: 1.24, P = .001), and longer operative times (≥95 minutes) (OR: 1.82, P < .001) were associated with 'outpatient' designation versus SDD. Within the hospital-defined 'outpatient' cohort, 49.1% (983 of 2,003) were discharged the same day (LOS = 0 days), and 21.8% had LOS 2 or more days. The hospital-defined 'outpatient' cohort had greater odds of nonhome discharges (6.3 versus 2.8%; OR: 1.88, P < .001) compared to SDD surgeries. The incidence was higher for any complication among hospital-defined 'outpatient' designated patients compared to SDD (5.5 versus 3.9%, P = .007). CONCLUSIONS Outpatient surgeries may be misleading and often do not correlate with SDD, as over 20% remain in the hospital 2 or more days. Investigators should quantitatively define the "outpatient" status by actual LOS to allow standardization and results comparison. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York; Questrom School of Business, Boston University, Boston, Massachusetts
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Jake Schwartz
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - C H J Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Michael A Mont
- Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| |
Collapse
|
8
|
Ghoshal S, Salazar C, Duggan J, Howell C, Chen AF, Shah VM. Assessment of Patient Satisfaction and Outcomes After Outpatient Joint Arthroplasty in Academic Medical Centers. Arthroplast Today 2023; 24:101246. [PMID: 38205059 PMCID: PMC10776316 DOI: 10.1016/j.artd.2023.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/26/2023] [Accepted: 09/19/2023] [Indexed: 01/12/2024] Open
Abstract
Background There is limited literature evaluating patient satisfaction and outcomes after outpatient joint arthroplasty procedures in academic medical centers (AMCs). The aims of this study are to determine: (1) patients' desires to repeat their procedures and be discharged on the same day, (2) patient-reported outcome measures (PROMs), (3) time to discharge, (4) readmission rates, and (5) factors that predict PROMs in patients undergoing outpatient joint arthroplasty in AMCs. Methods A prospective survey was completed by 66 total hip arthroplasty (THA), 35 total knee arthroplasty (TKA), and 180 unicondylar knee arthroplasty (UKA) outpatients who underwent surgery from May 2018 to December 2020 in 2 AMCs. The survey consisted of questions regarding hip or knee PROMs (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement), satisfaction with outpatient procedures and discharges, and reasons for readmissions. Linear regression analysis was conducted with statistical significance set at P < .05. Results 100% of THA, 93.8% of TKA, and 93.0% of UKA outpatients stated that they would re-elect to undergo their respective procedure. Furthermore, 94% of THA, 81% of TKA, and 95% of UKA patients stated they would like same-day discharge again. THA, TKA, and UKA patients reported respective mean PROM scores of 94.7, 89.9, and 86.1. Readmission rates were 1.5%, 0.0%, and 0.5%, for THA, TKA, and UKA, respectively. Conclusions Patients who underwent outpatient joint arthroplasty procedures at 2 AMCs experienced minimal readmissions and reported a high desire to repeat their outpatient procedures.
Collapse
Affiliation(s)
- Soham Ghoshal
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Carlos Salazar
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jessica Duggan
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Antonia F. Chen
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vivek M. Shah
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
9
|
Hachadorian M, Chang RN, Prentice HA, Paxton EW, Rao AG, Navarro RA, Singh A. Association between same-day discharge shoulder arthroplasty and risk of adverse events in patients with American Society of Anesthesiologists classification ≥3: a cohort study. J Shoulder Elbow Surg 2023; 32:e556-e564. [PMID: 37268285 DOI: 10.1016/j.jse.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Same-day discharge for shoulder arthroplasty (SA) is well-supported in the literature; however, most studies have focused on healthier patients. Indications for same-day discharge SA have expanded to include patients with more comorbidities, but safety of same-day discharge in this population remains unknown. We sought to compare outcomes following same-day discharge vs. inpatient SA in a cohort of patients considered higher risk for adverse events, defined as an American Society of Anesthesiologists (ASA) classification of ≥3. METHODS Data from Kaiser Permanente's SA registry were utilized to conduct a retrospective cohort study. All patients with an ASA classification of ≥3 who underwent primary elective anatomic or reverse SA in a hospital from 2018 to 2020 were included. The exposure of interest was in-hospital length of stay: same-day discharge vs. ≥1-night hospital inpatient stay. The likelihood of 90-day post-discharge events, including emergency department (ED) visit, readmission, cardiac complication, venous thromboembolism, and mortality, was evaluated using propensity score-weighted logistic regression with noninferiority testing using a margin of 1.10. RESULTS The cohort included a total of 1814 SA patients, of whom 1005 (55.4%) had same-day discharge. In propensity score-weighted models, same-day discharge was not inferior to an inpatient stay SA regarding 90-day readmission (odds ratio [OR] = 0.64, one-sided 95% upper bound [UB] = 0.89) and overall complications (OR = 0.67, 95% UB = 1.00). We lacked evidence in support of noninferiority for 90-day ED visit (OR = 0.96, 95% UB = 1.18), cardiac event (OR = 0.68, 95% UB = 1.11), or venous thromboembolism (OR = 0.91, 95% UB = 2.15). Infections, revisions for instability, and mortality were too rare to evaluate using regression analysis. CONCLUSIONS In a cohort of over 1800 patients with an ASA of ≥3, we found same-day discharge SA did not increase the likelihood of ED visits, readmissions, or complications compared with an inpatient stay, and same-day discharge was not inferior to an inpatient stay with regard to readmissions and overall complications. These findings suggest that it is possible to expand indications for same-day discharge SA in the hospital setting.
Collapse
Affiliation(s)
- Michael Hachadorian
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Richard N Chang
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, CA, USA
| | - Heather A Prentice
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, CA, USA
| | - Elizabeth W Paxton
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, CA, USA
| | - Anita G Rao
- Department of Orthopaedic Surgery, Northwest Permanente Medical Group, Vancouver, WA, USA
| | - Ronald A Navarro
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, South Bay, CA, USA
| | - Anshuman Singh
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, CA, USA.
| |
Collapse
|
10
|
Jensen CB, Troelsen A, Foss NB, Nielsen CS, Lindberg-Larsen M, Gromov K. No difference in short-term readmissions following day-case vs. one overnight stay in patients having hip and knee arthroplasty: a nationwide register study of 51,042 procedures from 2010-2020. Acta Orthop 2023; 94:516-522. [PMID: 37831058 PMCID: PMC10574241 DOI: 10.2340/17453674.2023.18658] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND AND PURPOSE Day-case hip and knee arthroplasty has gained in popularity, but there are conflicting results regarding readmissions. We aimed to investigate differences in 30- and 90-day readmission rates between day-case patients and patients with a single overnight stay following primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA). PATIENTS AND METHODS We identified day-case (DC) and overnight (ON) THA, TKA, and UKA patients, operated on between 2010 and 2020, from the Danish National Patient Register. Day-case surgery was defined as discharge on the day of surgery. Overnight readmissions within 30 or 90 days of surgery were considered readmissions. We compared readmission rates between DC and ON patients within arthroplasty types using logistic regression adjusted for patient characteristics and year of surgery. We included 29,486 THAs (1,353 DC and 28,133 ON), 15,116 TKAs (617 DC and 14,499 ON), and 6,440 UKAs (1,528 DC and 4,914 ON). RESULTS The 30-day readmission rates were: DC-THA 4.4% vs. ON-THA 4.4% (adjusted odds-ratio [aOR] 1.2, 95% confidence interval [CI] 0.91-1.6), DC-TKA 4.7% vs. ON-TKA 4.4% (aOR 1.1, CI 0.69-1.5), and DC-UKA 3.0% vs. ON-UKA 3.0% (aOR 1.1, CI 0.78-1.5). Similarly, no significant differences were present between DC and ON THA, TKA, and UKA regarding 90-day readmissions or time to readmission. CONCLUSION We found no differences in readmission rates between day-case THA, TKA, and UKA patients and patients with a single overnight stay.
Collapse
Affiliation(s)
- Christian Bredgaard Jensen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre.
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre
| | - Nicolai Bang Foss
- Department of Anesthesiology, Copenhagen University Hospital Hvidovre, Hvidovre
| | - Christian Skovgaard Nielsen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery, Orthopaedic Research Unit (ORU), Odense University Hospital, Odense, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre
| |
Collapse
|
11
|
Forslund JM, Chan PH, Prentice HA, Purdy AC, Khatod M. Preoperative Patient Optimization: Outcomes from Elective Total Joint Arthroplasty in a Large US Healthcare System. J Am Acad Orthop Surg 2023:00124635-990000000-00682. [PMID: 37130370 DOI: 10.5435/jaaos-d-23-00054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/01/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Patient factors are known to affect outcomes in arthroplasty surgery. A preoperative program to address modifiable factors may aid in more appropriate patient selection. We sought to assess patient selection and 90-day postoperative outcomes for total joint arthroplasty (TJA) candidates before and after implementation of a preoperative optimization protocol. METHODS A retrospective time-trend study using data from an integrated healthcare system's total joint replacement registry was done. The study sample consisted of patients aged 18 years or older who underwent primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis between 2009 and 2019. Patients were divided into two cohorts: procedures performed from 2009 to 2013 ("preoptimization protocol") and those from 2015 to 2019 ("postoptimization protocol"); 2014 was excluded because an evidence-based preoperative patient optimization protocol was progressively implemented throughout the year. Patient characteristics, optimization factors, and 90-day outcomes (including emergency department [ED] visits, readmission, all-cause revision, deep infection, venous thromboembolism, and mortality) were compared between the two cohorts using the Pearson chi-square test or Wilcoxon test. RESULTS The study sample included 25,925 THA and 60,484 TKA. In the THA cohort, 10,364 (40.0%) and 15,561 (60.0%) were from the preoptimization and postoptimization cohorts, respectively. The postoptimization THA cohort saw lower rates of ED visits (12.1% vs. 9.4%, P < 0.001) and readmissions (5.6% vs. 3.8%, P < 0.001). In the TKA cohort, 24,054 (39.8%) and 36,430 (60.2%) were from the preoptimization and postoptimization cohorts, respectively. The postoptimization TKA cohort saw lower rates of ED visits (13.1% vs. 11.9%, P < 0.001), readmissions (5.6% vs. 3.0%, P < 0.001), all-cause revisions (0.5% vs. 0.3%, P = 0.003), venous thromboembolism (1.3% vs. 0.9%, P < 0.001), and mortality (0.3% vs. 0.2%, P = 0.011). DISCUSSION An evidence-based protocol to improve patient selection based on modifiable patient factors was adopted by orthopaedic surgeons in the system and utilization of the protocol before TJA was associated with fewer postoperative complications over time. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Johan M Forslund
- From the Department of Orthopaedic Surgery, Scripps Clinic, San Diego, CA (Forslund), the Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA (Chan and Prentice), the Department of Surgery, Harbor-University of California, Torrance, CA (Purdy), and the Department of Orthopaedic Surgery, Southern California Permanente Medical Group, West Los Angeles, CA (Khatod)
| | | | | | | | | |
Collapse
|
12
|
Madsen HJ, Henderson WG, Dyas AR, Bronsert MR, Colborn KL, Lambert-Kerzner A, Meguid RA. Inpatient Versus Outpatient Surgery: A Comparison of Postoperative Mortality and Morbidity in Elective Operations. World J Surg 2023; 47:627-639. [PMID: 36380104 DOI: 10.1007/s00268-022-06819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Operations performed outpatient offer several benefits. The prevalence of outpatient operations is growing. Consequently, the proportion of patients with multiple comorbidities undergoing outpatient surgery is increasing. We compared 30-day mortality and overall morbidity between outpatient and inpatient elective operations. METHODS Using the 2005-2018 ACS-NSQIP database, we evaluated trends in percent of hospital outpatient operations performed over time, and the percent of operations done outpatient versus inpatient by CPT code. Patient characteristics were compared for outpatient versus inpatient operations. We compared unadjusted and risk-adjusted 30-day mortality and morbidity for inpatient and outpatient operations. RESULTS A total of 6,494,298 patients were included. The proportion of outpatient operations increased over time, from 37.8% in 2005 to 48.2% in 2018. We analyzed the 50 most frequent operations performed outpatient versus inpatient 25-75% of the time (n = 1,743,097). Patients having outpatient operations were younger (51.6 vs 54.6 years), female (70.3% vs 67.3%), had fewer comorbidities, and lower ASA class (I-II, 69.3% vs. 59.9%). On both unadjusted and risk-adjusted analysis, 30-day mortality and overall morbidity were less likely in outpatient versus inpatient operations. CONCLUSION In this large multi-specialty analysis, we found that patients undergoing outpatient surgery had lower risk of 30-day morbidity and mortality than those undergoing the same inpatient operation. Patients having outpatient surgery were generally healthier, suggesting careful patient selection occurred even with increasing outpatient operation frequency. Patients and providers can feel reassured that outpatient operations are a safe, reasonable option for selected patients.
Collapse
Affiliation(s)
- Helen J Madsen
- Surgical Outcomes and Applied Research Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, Room 6602, Aurora, CO, 80045, USA.
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, Room 6602, Aurora, CO, 80045, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Adam R Dyas
- Surgical Outcomes and Applied Research Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, Room 6602, Aurora, CO, 80045, USA
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, Room 6602, Aurora, CO, 80045, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, Room 6602, Aurora, CO, 80045, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Anne Lambert-Kerzner
- Surgical Outcomes and Applied Research Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, Room 6602, Aurora, CO, 80045, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 E. 17th Avenue, C-310, Room 6602, Aurora, CO, 80045, USA. .,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
13
|
Abella MKIL, Ezeanyika CN, Finlay AK, Amanatullah DF. Identifying Risk Factors for Complication and Readmission with Same-Day Discharge Arthroplasty. J Arthroplasty 2022; 38:1010-1015.e2. [PMID: 36572233 PMCID: PMC9783142 DOI: 10.1016/j.arth.2022.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic caused a surge of same-day discharge (SDD) for total joint arthroplasty. However, SDD may not be beneficial for all patients. Therefore, continued investigation into the safety of SDD is necessary as well as risk stratification for improved patient outcomes. METHODS This retrospective cohort study examined 31,851 elective SDD hip and knee arthroplasties from 2016 to 2020 in a large national database. Logistic regression models were used to identify patient variables and preoperative comorbidities that contribute to postoperative complication or readmission with SDD. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. RESULTS SDD increased from 1.4% in 2016 to 14.6% in 2020. SDD is associated with lower odds of readmission (AOR: 0.994, CI: 0.992-0.996) and postoperative complications (AOR: 0.998, CI: 0.997-1.000). Patients who have preoperative dyspnea (AOR: 1.03, CI: 1.02-1.04, P < .001), chronic obstructive pulmonary disease (AOR: 1.02, CI: 1.01-1.03, P = .002), and hypoalbuminemia (AOR: 1.02, CI: 1.00-1.03, P < .001), had higher odds of postoperative complications. Patients who had preoperative dyspnea (AOR: 1.02, CI: 1.01-1.03), hypertension (AOR: 1.01, CI: 1.01-1.03, P = .003), chronic corticosteroid use (AOR: 1.02, CI: 1.01-1.03, P < .001), bleeding disorder (AOR: 1.02; CI: 1.01-1.03, P < .001), and hypoalbuminemia (AOR: 1.01, CI: 1.00-1.02, P = .038), had higher odds of readmission. CONCLUSION SDD is safe with certain comorbidities. Preoperative screening for cardiopulmonary comorbidities (eg, dyspnea, hypertension, and chronic obstructive pulmonary disease), chronic corticosteroid use, bleeding disorder, and hypoalbuminemia may improve SDD outcomes.
Collapse
Affiliation(s)
- Maveric K I L Abella
- Stanford University Department of Orthopaedic Surgery, Redwood City, California; University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Chukwunweike N Ezeanyika
- Stanford University Department of Orthopaedic Surgery, Redwood City, California; Northeast Ohio Medical University, Rootstown, Ohio
| | - Andrea K Finlay
- Stanford University Department of Orthopaedic Surgery, Redwood City, California
| | - Derek F Amanatullah
- Stanford University Department of Orthopaedic Surgery, Redwood City, California
| |
Collapse
|
14
|
Hammerberg EM, Tucker NJ, Stacey SC, Mauffrey C, Heare A, Verduzco LA, Parry JA. Institution of same-day total joint replacement at an urban safety net hospital during the COVID-19 pandemic. J Orthop 2022; 34:173-177. [PMID: 36060728 PMCID: PMC9422337 DOI: 10.1016/j.jor.2022.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Increasingly, total hip and total knee replacements are being performed at outpatient ambulatory surgery centers. The purpose of this study was to investigate the feasibility and safety of instituting a same-day surgery program for hip and knee replacement at an urban, safety net hospital. Methods Retrospective review of a prospectively collected registry for all patients scheduled for same-day total joint replacement at a safety net hospital was performed. Medical records were reviewed for patient demographics, same-day hospital admissions, and 30-day emergency room/hospital admissions. Results 131 same-day total joint replacements were identified, including 76 knees and 55 hips. Median ASA was 3, and median Charlson comorbidity score was 2. Rate of same-day surgery for total joint replacements increased from 4.5% in September 2020 to 100% in September 2021. On major patient outcomes, 3.8% of patients (n = 5) required conversion to inpatient admission. Rate of 30-Day Emergency Department (ED) visits was 13.0% (n = 17). Most common complaints included postoperative pain (n = 10), incision drainage/edema/hematoma (n = 9), and cellulitis (n = 2). 30-Day Hospital Readmissions occurred in 1.5% of patients (n = 2). Conclusion Same-day hip and knee replacement can be performed safely at a safety net hospital. Unlike dedicated high-volume orthopedic hospitals or outpatient surgery centers, urban safety net hospitals face a different set of challenges and must care for a wide variety of patients who do not plan for their illness and/or may not be able to pay for their care. Outpatient total joint replacement may extend total joint replacement to patients who might not have access otherwise.
Collapse
Affiliation(s)
- E. Mark Hammerberg
- Denver Health Medical Center, Department of Orthopedic Surgery, 777 Bannock St, Denver, CO, 80204, USA
- University of Colorado School of Medicine, Department of Orthopedics, CU Anschutz Academic Office One, 12631 East 17th Avenue, #4602, Aurora, CO, 80045, USA
- Corresponding author. Denver Health Medical Center, Department of Orthopedic Surgery , 777 Bannock St, Denver, CO 80204, USA
| | - Nicholas J. Tucker
- Denver Health Medical Center, Department of Orthopedic Surgery, 777 Bannock St, Denver, CO, 80204, USA
- University of Colorado School of Medicine, Department of Orthopedics, CU Anschutz Academic Office One, 12631 East 17th Avenue, #4602, Aurora, CO, 80045, USA
| | - Stephen C. Stacey
- Denver Health Medical Center, Department of Orthopedic Surgery, 777 Bannock St, Denver, CO, 80204, USA
- University of Colorado School of Medicine, Department of Orthopedics, CU Anschutz Academic Office One, 12631 East 17th Avenue, #4602, Aurora, CO, 80045, USA
| | - Cyril Mauffrey
- Denver Health Medical Center, Department of Orthopedic Surgery, 777 Bannock St, Denver, CO, 80204, USA
- University of Colorado School of Medicine, Department of Orthopedics, CU Anschutz Academic Office One, 12631 East 17th Avenue, #4602, Aurora, CO, 80045, USA
| | - Austin Heare
- Denver Health Medical Center, Department of Orthopedic Surgery, 777 Bannock St, Denver, CO, 80204, USA
- University of Colorado School of Medicine, Department of Orthopedics, CU Anschutz Academic Office One, 12631 East 17th Avenue, #4602, Aurora, CO, 80045, USA
| | - Luis A. Verduzco
- Denver Health Medical Center, Department of Anesthesiology, USA
- University of Colorado School of Medicine, Department of Anesthesiology, USA
| | - Joshua A. Parry
- Denver Health Medical Center, Department of Orthopedic Surgery, 777 Bannock St, Denver, CO, 80204, USA
- University of Colorado School of Medicine, Department of Orthopedics, CU Anschutz Academic Office One, 12631 East 17th Avenue, #4602, Aurora, CO, 80045, USA
| |
Collapse
|
15
|
Singh V, Kurapatti M, Anil U, Macaulay W, Schwarzkopf R, Davidovitch RI. Evaluation of Emergency Department Visits Following Total Joint Arthroplasty: Same-Day Discharge vs Non-Same-Day Discharge. J Arthroplasty 2022; 37:1017-1022. [PMID: 35181447 DOI: 10.1016/j.arth.2022.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Traditionally, most efforts have focused on readmission rates while little has been reported on emergency department (ED) presentation. This study aims to analyze the difference between same-day discharge (SDD) and non-SDD primary total hip and knee arthroplasty cases to determine the rate and reasons associated with 90-day ED presentations. METHODS We retrospectively reviewed all patients who underwent primary total hip arthroplasty and total knee arthroplasty between 2011 and 2021. The patients were separated into 2 cohorts: (1) SDD and (2) required a longer length of stay. The primary outcome was an ED visit within 90 days of the index operation. Secondary outcomes included reasons for ED visits and readmission rates. Multivariable logistic regressions were performed to compare the 2 groups while accounting for significant demographic variables. RESULTS Of the 24,933 patients included, 1,725 (7%) were SDD and 23,208 (93%) required a longer length of stay. The overall rate of 90-day ED visits was significantly lower for patients who were SDD compared to non-SDD (1.6% vs 4.0%, P = .004). However, when stratified based on the reason for ED visit, no single cause was significant between the 2 cohorts. The most commonly reported reasons were pain (32.1% vs 26.7%, P = .064) and other non-orthopedic-related medical issues (25.0% vs 29.5%, P = .206). Among those who presented to the ED, the readmission rate did not statistically differ (25.0% vs 23.4%, P = .131). CONCLUSION Patients who underwent SDD were less likely to present to the ED within 90 days following their surgery compared to non-SDD. Approximately three fourths of the patients in both cohorts that visited the ED did not require readmission. Future efforts should focus on developing interventions to reduce the burden of these visits on the healthcare system. LEVEL III EVIDENCE Retrospective Cohort Study.
Collapse
Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Mark Kurapatti
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Utkarsh Anil
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | |
Collapse
|
16
|
Debbi EM, Mosich GM, Bendich I, Kapadia M, Ast MP, Westrich GH. Same-Day Discharge Total Hip and Knee Arthroplasty: Trends, Complications, and Readmission Rates. J Arthroplasty 2022; 37:444-448.e1. [PMID: 34808278 DOI: 10.1016/j.arth.2021.11.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/23/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) are transitioning to surgery centers, there remain limited data on trends, comorbidities, and complications in patients discharged the same day of surgery. In addition, many studies are limited to the Medicare population, excluding a large proportion of outpatient surgery patients. METHODS Primary, elective THA/TKA cases between 2010 and 2017 were retrospectively identified using the PearlDiver All-Payer Database and separated based on surgery as well as same-day discharge (SDD) or non-SDD. Data were collected on demographics, rates, comorbidities, and complications. Multivariable logistic regression determined adjusted odds ratios (ORs) for 90-day complications requiring readmission for each group. RESULTS In total, 1,789,601 (68.8% TKA, 31.2% THA) patients were identified where 2.9% of TKAs and 2.2% of THAs were SDD. Annual SDD rates are increasing, with a 15.8% mean annual change for SDD-THA and 11.1% for SDD-TKA (P < .001). SDD patients were younger with fewer comorbidities (P < .001). Regression analysis showed an overall slightly higher OR of complications requiring readmission for SDD-TKA vs non-SDD-TKA (OR 1.14, 95% confidence interval [CI] 1.07-1.21, P < .001). There was no significant difference for SDD-THA vs non-SDD-THA (OR 1.03, 95% CI 0.94-1.13, P = .49). In univariate analysis, SDD-THA vs SDD-TKA had more mechanical complications (P < .001), but less pulmonary embolisms (P < .001). Regression analysis showed a slightly higher risk of complications for SDD-THA vs SDD-TKA (OR 1.19, 95% CI 0.99-1.44, P = .05). CONCLUSION The prevalence of SDD is rising. SDD-THA is increasing more rapidly than SDD-TKA. SDD patients are generally younger with fewer comorbidities. SDD-TKA has slightly higher odds of complications requiring readmission than non-SDD-TKA. SDD-THA and SDD-TKA have different complication profiles.
Collapse
Affiliation(s)
- Eytan M Debbi
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Gina M Mosich
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Ilya Bendich
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Milan Kapadia
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Michael P Ast
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Geoffrey H Westrich
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| |
Collapse
|
17
|
Reddy NC, Prentice HA, Paxton EW, Hinman AD, Lin AG, Navarro RA. Association Between Same-Day Discharge Total Joint Arthroplasty and Risk of 90-Day Adverse Events in Patients with ASA Classification of ≥3. J Bone Joint Surg Am 2021; 103:2032-2044. [PMID: 34495903 DOI: 10.2106/jbjs.20.02110] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although safety in same-day discharge total joint arthroplasty (TJA) has been reported, findings are limited to healthier patients, specific surgeons, and/or specific institutions. Indications for same-day discharge TJA have expanded to include patients with multiple comorbidities; however, safety in this specific patient population remains unknown. Therefore, we sought to compare the risk of 90-day adverse events in higher-risk patients undergoing same-day discharge versus inpatient TJA. METHODS The Kaiser Permanente Total Joint Replacement Registry was utilized to conduct a cohort study. All patients with an American Society of Anesthesiologists (ASA) classification of ≥3 who underwent primary elective TJA for osteoarthritis from 2017 through 2018 were identified. The risk of 90-day adverse events (i.e., emergency department visits, unplanned readmissions, complications, and mortality) was evaluated with use of propensity score-weighted Cox proportional hazard regression including noninferiority testing with a margin of 1.10. RESULTS The cohort included a total of 5,250 patients who underwent total hip arthroplasty and 9,752 patients who underwent total knee arthroplasty, of whom 1,742 (33.2%) and 3,283 (33.7%) had same-day discharge, respectively. Same-day discharge hip arthroplasty was noninferior to an inpatient stay in terms of emergency department visits (hazard ratio [HR], 0.73; 1-sided HR 95% upper bound [UB], 0.84), readmissions (HR, 0.47; 95% UB, 0.61), and complications (HR, 0.63; 95% UB, 0.75); we did not have evidence of noninferiority for mortality (HR, 0.84; 95% UB, 1.97). Same-day discharge knee arthroplasty was noninferior to an inpatient stay in terms of emergency department visits (HR, 0.79; 95% UB, 0.87), readmission (HR, 0.80; 95% UB, 0.95), complications (HR, 0.72; 95% UB, 0.82), and mortality (HR, 0.53; 95% UB, 1.03). CONCLUSIONS We found that same-day discharge TJA did not increase the risk of emergency department visits, unplanned readmissions, and complications compared with an inpatient stay for higher-risk patients, suggesting that it is possible to expand indications for same-day discharge TJA in the hospital setting while maintaining safety. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Nithin C Reddy
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, California
| | - Heather A Prentice
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California
| | - Adrian D Hinman
- Department of Orthopaedics, The Permanente Medical Group, San Leandro, California
| | - Abraham G Lin
- Department of Orthopaedics, Southern California Permanente Medical Group, Irvine, California
| | - Ronald A Navarro
- Department of Orthopaedics, Southern California Permanente Medical Group, Harbor City, California
| |
Collapse
|