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Zhu JW, Wang TF, Chen DS, Lei L. Safety evaluation of outpatient vs inpatient unicompartmental knee arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05446-8. [PMID: 39002050 DOI: 10.1007/s00402-024-05446-8] [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: 05/08/2023] [Accepted: 06/27/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the safety of outpatient and inpatient Unicompartmental Knee Arthroplasty (UKA) based on the incidence of adverse events. METHOD A systematic search of the literature was performed in October 2022 on PubMed, Web of Science, Cochrane library, and Embase. The Meta package for R was used to perform the meta-analysis. RESULT Five studies with a total of 26,301 patients were included. 5813 patients (22.1%) were treated with outpatient UKA, and 20,488 patients (77.9%) were treated with inpatient UKA. There were no statistically significant differences in the incidence of total complications (RR = 1.36, 95% CI = 0.64-2.89, Z = 0.79, P = 0.43), readmission (RR = 1.02, 95% CI = 0.40-2.60, Z = 0.05, P = 0.96), and venous thrombosis (RR = 1.43, 95% CI = 0.96-2.11, Z = 1.78, P = 0.08). Incidence rates were lower in outpatient UKA regarding urinary tract infection (RR = 1.48, 95% CI = 1.07-2.04, Z = 2.40, P = 0.02), pulmonary embolus (RR = 7.48, 95% CI = 1.80-31.17, Z = 2.76, P < 0.01), and transfusion (RR = 2.77, 95% CI = 1.63-4.71, Z = 3.78, P < 0.01). CONCLUSION In summary, outpatient UKA shows lower incidences of hospital-acquired complications such urinary tract infection, pulmonary embolus, and transfusion. It's worth noting that the incidences of total complications, readmission, and venous thrombosis in outpatient UKA were not higher than the incidences of inpatient UKA, suggestting that outpatient UKA can be considered a safe alternative to inpatient UKA.
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Affiliation(s)
- Jia-Wang Zhu
- Department of Sports Medicine and Arthroscopy, Tianjin Hospital of Tianjin University, Tianjin, China
| | - Tong-Fu Wang
- Department of Sports Medicine and Arthroscopy, Tianjin Hospital of Tianjin University, Tianjin, China
| | - De-Sheng Chen
- Department of Sports Medicine and Arthroscopy, Tianjin Hospital of Tianjin University, Tianjin, China.
| | - Lei Lei
- Department of Sports Medicine and Arthroscopy, Tianjin Hospital of Tianjin University, Tianjin, China
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Potter BK. From Bench to Bedside: Size Matters-Needle Arthroscopy for Office-based Diagnosis. Clin Orthop Relat Res 2024; 482:1133-1134. [PMID: 38713907 PMCID: PMC11219142 DOI: 10.1097/corr.0000000000003105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Benjamin K Potter
- Norman M. Rich Professor & Chair, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD, USA
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3
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Nin DZ, Chen YW, Talmo CT, Hollenbeck BL, Mattingly D, Niu R, Chang DC, Smith EL. Revision Total Knee Arthroplasty in an Outpatient Setting: A Growing Alternative. J Arthroplasty 2024:S0883-5403(24)00519-9. [PMID: 38797450 DOI: 10.1016/j.arth.2024.05.047] [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: 12/01/2023] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Recent studies have focused on the safety and efficacy of performing primary total knee arthroplasty (TKA) in an outpatient setting. Despite being associated with greater costs, much less is known about the accompanying impact on revision TKA (rTKA). The purpose of this study was to describe the trends in costs and outcomes of patients undergoing inpatient and outpatient rTKA. METHODS An observational cohort study was conducted using commercial claims databases. Patients who underwent 1-component and 2-component rTKA in an inpatient setting, hospital outpatient department (HOPD), or ambulatory surgery center (ASC) from 2018 to 2020 were included. The primary outcome was the 30-day episode-of-care costs following rTKA. Secondary outcomes included surgical cost, 90-day readmission rate, and emergency department visit rate. Covariates for analyses included patient demographics, surgery type, and indication for revision. RESULTS There were 6,515 patients who were identified, with 17.0% of rTKAs taking place in an outpatient setting. On adjusted analysis, patients in the highest quartile of 30-day postoperative costs were more likely to be those whose rTKA was performed in an inpatient setting. One-component revisions were more common in an outpatient setting (HOPD, 50.7%; ASC, 62.0%) compared to an inpatient setting (39.6%). The 90-day readmission rates were higher (P = .003) for rTKAs performed in inpatient (+9.2%) and HOPD (+8.6%) settings compared to those in an ASC. CONCLUSIONS The ASC may be a suitable setting for simpler revisions performed for less severe indications and is associated with lower costs and 90-day readmission and emergency department visit rates.
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Affiliation(s)
- Darren Z Nin
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carl T Talmo
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Brian L Hollenbeck
- Division of Infectious Diseases, New England Baptist Hospital, Boston, Massachusetts
| | - David Mattingly
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Ruijia Niu
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - David C Chang
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric L Smith
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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Gebrelul A, Malhotra S, Sigueza AL, Singer E, Ast MP, Sheth NP. Increasing the Volume of Outpatient Total Joint Arthroplasty Procedures: An Evaluation of a Novel Rapid Recovery Pathway Program Within an Academic Medical Center. HSS J 2024; 20:35-40. [PMID: 38356745 PMCID: PMC10863602 DOI: 10.1177/15563316231211335] [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: 06/16/2023] [Accepted: 10/10/2023] [Indexed: 02/16/2024]
Abstract
Background There has been a national trend toward shifting joint arthroplasty procedures to the outpatient setting. These cases are often performed in freestanding ambulatory surgery centers (ASCs), which are often not accessible to surgeons within academic practices. Purposes We sought to investigate a novel rapid recovery program used to transition arthroplasty patients to an outpatient-based care system within an academic medical center. Methods All patients undergoing hip or knee arthroplasty between November 2019 and April 2021 were retrospectively evaluated for their eligibility for a rapid recovery pathway through the Extended Stay Unit (ESU) based on clinical and social criteria. Once admitted, patients were evaluated for whether they were discharged from the unit or if hospital admission was necessary. Results Out of the 444 patients deemed candidates for the rapid recovery program, 188 patients were admitted to the ESU (42.3%); 18 (9.6%) required inpatient hospital admission, with the majority of these due to failing physical therapy (16; 88.9%). Of the ESU patients who were successfully discharged home, 55 (32.4%) were discharged on postoperative day (POD) 0 and 115 (67.6%) on POD 1 (<23 hours). Conclusion As total joint arthroplasties shift toward the outpatient setting, surgeons in academic institutions must employ strategies to increase their volume of patient candidates for outpatient procedures. Our retrospective study of prospectively collected data suggests the feasibility of creating a separate rapid recovery unit within the hospital that can be an effective method by which to eventually transition to the ASC setting.
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Affiliation(s)
| | - Shiv Malhotra
- Sophie Davis School of Biomedical Education, New York, NY, USA
| | - Anna L Sigueza
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Esme Singer
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael P Ast
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Patel S, Buller LT. Outpatient Hip and Knee Arthroplasty Can be Safe in Patients With Multiple Medical Comorbidities via Use of Evidence-Based Perioperative Protocols. HSS J 2024; 20:75-82. [PMID: 38356746 PMCID: PMC10863597 DOI: 10.1177/15563316231208431] [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: 05/08/2023] [Accepted: 06/02/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Sohum Patel
- Department of Orthopedic Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Leonard T Buller
- Department of Orthopedic Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA
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Migliorini F, Feierabend M, Hofmann UK. Fostering Excellence in Knee Arthroplasty: Developing Optimal Patient Care Pathways and Inspiring Knowledge Transfer of Advanced Surgical Techniques. J Healthc Leadersh 2023; 15:327-338. [PMID: 38020721 PMCID: PMC10676205 DOI: 10.2147/jhl.s383916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Osteoarthritis of the knee is common. Early sports trauma or cartilage defects are risk factors for osteoarthritis. If conservative treatment fails, partial or total joint replacement is often performed. A joint replacement aims to restore physiological biomechanics and the quality of life of affected patients. Total knee arthroplasty is one of the most performed surgeries in musculoskeletal medicine. Several developments have taken place over the last decades that have truly altered the way we look at knee arthroplasty today. Some of the fascinating aspects will be presented and discussed in the present narrative review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100 Bolzano, Italy
| | - Martina Feierabend
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
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Anastasio AT, Kim BI, Cochrane NH, Belay E, Bolognesi MP, Talaski GM, Ryan SP. Higher Risk of Reoperation after Total Knee Arthroplasty in Young and Elderly Patients. MATERIALS (BASEL, SWITZERLAND) 2023; 16:7012. [PMID: 37959609 PMCID: PMC10648704 DOI: 10.3390/ma16217012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/30/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
As outcomes and survivorship improve, total knee arthroplasty (TKA) has expanded into broader age groups. The purpose of this study is to analyze the impact of age on TKA outcomes using the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2020. Patients were categorized into young (40-49 years), middle (50-79 years), and elderly (80-89 years) groups. Findings reveal notable differences across age groups. The young cohort had the highest BMI, smoking incidence, and steroid use, while the elderly group exhibited a higher prevalence of comorbidities. Young patients experienced shorter hospital stays (p < 0.001) but longer operative times (p < 0.001), and outpatient surgery was most common in the middle age group. Multivariable regression demonstrated that the elderly group faced increased risks of pneumonia (p < 0.001), acute renal failure (p < 0.001), stroke (p < 0.001), cardiac arrest (p < 0.001), and transfusions (p < 0.001), while both young and elderly patients had higher 30-day reoperation risks (youngest cohort, 1.4% and elderly cohort 1.3% (p < 0.001)). In summary, elderly patients undergoing TKA are at the highest risk for medical complications, while young patients are more likely to undergo inpatient surgery, experience reoperations, and have longer operative times. This study underscores the importance of age-specific counseling for TKA patients and contributes valuable insights into the evolving landscape of knee replacement surgery.
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Affiliation(s)
- Albert T. Anastasio
- Department of Orthopedic Surgery, Duke University, Durham, NC 27707, USA; (A.T.A.); (N.H.C.); (E.B.); (M.P.B.); (S.P.R.)
| | - Billy I. Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, NY 10021, USA;
| | - Niall H. Cochrane
- Department of Orthopedic Surgery, Duke University, Durham, NC 27707, USA; (A.T.A.); (N.H.C.); (E.B.); (M.P.B.); (S.P.R.)
| | - Elshaday Belay
- Department of Orthopedic Surgery, Duke University, Durham, NC 27707, USA; (A.T.A.); (N.H.C.); (E.B.); (M.P.B.); (S.P.R.)
| | - Michael P. Bolognesi
- Department of Orthopedic Surgery, Duke University, Durham, NC 27707, USA; (A.T.A.); (N.H.C.); (E.B.); (M.P.B.); (S.P.R.)
| | | | - Sean P. Ryan
- Department of Orthopedic Surgery, Duke University, Durham, NC 27707, USA; (A.T.A.); (N.H.C.); (E.B.); (M.P.B.); (S.P.R.)
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8
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Blackman A. Editorial Commentary: Cost Savings Related to Ambulatory Surgery Center Use Almost Exclusively Benefit the Payor. Arthroscopy 2023; 39:2325-2326. [PMID: 37866874 DOI: 10.1016/j.arthro.2023.05.013] [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: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 10/24/2023]
Abstract
Use of ambulatory surgery centers for orthopaedic procedures has been on the rise. The cost of any given ambulatory procedure tends to be less at an ambulatory surgery center than at a hospital outpatient department. People may assume that these cost savings benefit the patient, but recent research using claims and reimbursement databases shows minimal patient out-of-pocket cost reduction, and this minimal reduction is gradually increasing. The research also shows lower surgeon and facility reimbursement. The payor primarily benefits. The explanation probably lies in the fact that for procedures such as hip arthroscopy, patients are likely to meet their deductibles and out-of-pocket maximums regardless of venue, and any cost reduction for these types of procedures almost exclusively benefits the payor. Compounding this, increasing deductibles and copayment requirements, as have been prevalent in recent years, likely contribute to overall increased patient out-of-pocket expenditures seen over time.
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Xu S, Liow MHL, Liu XE, Pang HN, Chia SL, Tay KJD, Yeo SJ, Chen JY. Enhanced recovery after day surgery total knee arthroplasty, the new standard of care: An Asian perspective. Knee 2023; 44:158-164. [PMID: 37672906 DOI: 10.1016/j.knee.2023.08.003] [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: 05/01/2023] [Revised: 07/09/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND This study describes the implementation of Enhanced Recovery After Surgery (ERAS) total knee arthroplasty (TKA) with day-surgery protocol to assess the outcome of ERAS day surgery TKA compared with traditional ERAS inpatient TKA in terms of length of stay (LOS), 30-day readmission, complications, and patient-reported outcome measures (PROMs). METHODS Patients who underwent unilateral primary TKA from August 2020 to July 2021 were followed up. All TKAs were performed with the ERAS protocol. Patients who fulfilled the following inclusion criteria were offered day-surgery protocol: (1) ASA ≤ 3; (2) agreeable for discharge home. In addition, this day-surgery protocol comprised the following: (i) on-call physiotherapy review; (ii) home visit by physiotherapist at 1 week postoperative; (iii) home visit by nurse at 2 weeks postoperative. Day surgery was defined as discharge within 24 h. Patients were followed up for 6 months and PROMs, postoperative complications, and re-admissions recorded. RESULTS A total of 738 patients were included (342 ERAS day surgery, 396 ERAS inpatient). 92.4% of patients in the day-surgery group were successfully discharged within 24 h, leading to a shorter mean LOS of 1.13 days compared with 4.12 days in the inpatient group (P < 0.005). Both groups achieved significant and comparable improvement in Knee Society Score, Oxford Knee Score, and Physical and Mental component of Short Form-36. Both groups had similar rate of 30-day readmission and complications. CONCLUSION Patients who underwent ERAS day surgery TKA achieved similar functional and quality of life improvement compared with ERAS inpatient TKA with no increased complication rate. ERAS day surgery TKA is safe and cost effective, and its use should be promoted.
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Affiliation(s)
- Sheng Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | | | - Xuan Eric Liu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Hee-Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Calkins TE, Baessler AM, Throckmorton TW, Black C, Bernholt DL, Azar FM, Brolin TJ. Safety and short-term outcomes of anatomic vs. reverse total shoulder arthroplasty in an ambulatory surgery center. J Shoulder Elbow Surg 2022; 31:2497-2505. [PMID: 35718256 DOI: 10.1016/j.jse.2022.05.010] [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: 02/18/2022] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A scarcity of literature exists comparing outcomes of outpatient anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA). This study was performed to compare early outcomes between the 2 procedures in a freestanding ambulatory surgery center (ASC) and to determine if the addition of preoperative interscalene nerve block (ISNB) with periarticular liposomal bupivacaine injection (PAI) in the postanesthesia care unit (PACU) would improve outcomes over PAI alone. METHODS Medical charts of all patients undergoing outpatient primary aTSA or rTSA at 2 ASCs from 2012 to 2020 were reviewed. A total of 198 patients were ultimately identified (117 aTSA and 81 rTSA) to make up this retrospective cohort study. Patient demographics, PACU outcomes, complications, readmissions, reoperations, calls to the office, and unplanned clinic visit rates were compared between procedures. PACU outcomes were compared between those receiving ISNB with PAI and those receiving PAI alone. RESULTS Patients undergoing rTSA were older (61.1 vs. 55.7 years, P < .001) and more likely to have American Society of Anesthesiologists (ASA) class 3 (51.9% vs. 41.0%, P = .050) compared to patients having aTSA. No patient required an overnight stay. Time in the PACU before discharge (89.1 vs. 95.6 minutes, P = .231) and pain scores at discharge (3.0 vs. 3.0, P = .815) were similar for aTSA and rTSA, respectively. One intraoperative complication occurred in the aTSA group (posterior humeral circumflex artery injury) and 1 in the rTSA group (calcar fracture) (P = .793). Ninety-day postoperative total complication (7.7% vs. 7.4%), shoulder-related complication (6.0% vs. 6.2%), medical-related complication (1.7% vs. 1.2%), admission (0.8% vs. 2.5%), reoperation (2.6% vs. 1.2%), and unplanned clinic visit (6.0% vs. 6.1%) rates were similar between aTSA and rTSA, respectively (P ≥ .361 for all comparisons). At 1 year, there were 8 reoperations and 15 complications in the aTSA group compared with 1 reoperation and 8 complications in the rTSA group (P = .091 and P = .818, respectively). Patients who had ISNB spent less time in PACU (75 vs. 97 minutes, P < .001), had less pain at discharge (0.2 vs. 3.9, P < .001), and consumed less oral morphine equivalents in the PACU (1.2 vs. 16.6 mg, P < .001). CONCLUSION Early postoperative outcomes and complication rates were similar between the 2 groups, and all patients were successfully discharged home the day of surgery. The addition of preoperative ISNB led to more efficient discharge from the ASC with less pain in the PACU.
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Affiliation(s)
- Tyler E Calkins
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Aaron M Baessler
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Carson Black
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David L Bernholt
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Frederick M Azar
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
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Cutting-Edge Approaches in Arthroplasty: Before, during and after Surgery. J Pers Med 2022; 12:jpm12101671. [PMID: 36294810 PMCID: PMC9605126 DOI: 10.3390/jpm12101671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022] Open
Abstract
Personalised medicine was introduced in arthroplasty a long time ago with the aim of respecting each individual person for their unique personal characteristics in order to further improve outcomes [...].
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12
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Regional versus general anesthesia for ambulatory total hip and knee arthroplasty. Curr Opin Anaesthesiol 2022; 35:621-625. [PMID: 35900744 DOI: 10.1097/aco.0000000000001170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW With the removal of both total knee and total hip arthroplasty from the Centers for Medicare and Medicaid Services' inpatient-only list, efforts to improve efficiency of the perioperative management of total joint patients have increased recently. The publication of several recent studies examining the impact of anesthesia type on outcomes has prompted the need to review the overall state of evidence for spinal versus general anesthesia for outpatient total joint arthroplasty. RECENT FINDINGS Overall complication rates are low in this carefully selected patient population. The majority of patients who are preselected for outpatient total joint arthroplasty appear to successfully achieve this outcome. Some retrospective studies have suggested a benefit for spinal anesthesia in terms of same-day discharge success but direct comparisons in prospective studies are lacking. SUMMARY The type of anesthesia used for total joint arthroplasty may have an important effect on outcomes. Until randomized control trials are performed we must rely on existing evidence, which suggests that both spinal and general anesthesia can lead to successful outcomes after ambulatory total joint arthroplasty.
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Short-Stay Arthroplasty is Not Associated With Increased Risk of 90-Day Hospital Returns. J Arthroplasty 2022; 37:S819-S822. [PMID: 35093543 DOI: 10.1016/j.arth.2022.01.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND With the removal of total hip arthroplasty (THA) and total knee arthroplasty (TKA) from the inpatient-only list, medical centers are faced with challenging transitions to outpatient surgery. We investigated if short-stay arthroplasty, defined as length of stay (LOS) <24 hours, would influence 90-day readmissions and emergency department (ED) visits at a tertiary referral center. METHODS The institutional database was retrospectively queried for primary TKAs and THAs from July 2015 to January 2018, resulting in 2,217 patients (1,361 TKA and 856 THA). Patient demographics, including age, gender, body mass index, and American Society of Anesthesiologists score were collected. LOS, disposition, cost of care, 90-day ED visits, and readmissions were identified through the institutional database using electronic medical record data. Univariable and multivariable models were used to evaluate rates of 90-day readmissions and ED visits based on LOS <24 hours vs ≥24 hours. RESULTS LOS <24 h was associated with significant decreases in 90-day ED visits (P = .003) and readmissions (P = .002). After controlling for potential confounding variables with a multivariable model, a significant decrease in ED visits (P = .034) remained in the THA cohort alone. Within TKA and THA cohorts, LOS <24 h was associated with lower costs (P < .001). Eighteen percent of patients with ≥24 h LOS were discharged to skilled nursing or rehabilitation facilities. CONCLUSION In this cohort, LOS <24 hours was associated with decreased 90-day readmissions, ED visits, and costs. With the goal of minimizing costs and maintaining patient safety while efficiently using resources, outpatient and short-stay arthroplasty are valuable, feasible options in tertiary academic centers.
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Ezuma CO, Lu Y, Pareek A, Wilbur R, Krych AJ, Forsythe B, Camp CL. A Machine Learning Algorithm Outperforms Traditional Multiple Regression to Predict Risk of Unplanned Overnight Stay Following Outpatient Medial Patellofemoral Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e1103-e1110. [PMID: 35747652 PMCID: PMC9210490 DOI: 10.1016/j.asmr.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/28/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose To determine whether conventional logistic regression or machine learning algorithms were more precise in identifying the risk factors for unplanned overnight admission after medial patellofemoral ligament (MPFL) reconstruction. Methods A retrospective review of the prospectively collected National Surgical Quality Improvement Program database was performed to identify patients who underwent outpatient MPFL reconstruction from 2006–2018. Patients admitted overnight were identified as those with length of stay of 1 or more days. Models were generated using random forest, extreme gradient boosting, adaptive boosting, or elastic net penalized logistic regression, and an additional model was produced as a weighted ensemble of the 4 final algorithms. The predictive capacity of these models was compared to that of logistic regression. Results Of the 1307 patients identified, 221 (16.9%) required at least one overnight stay after MPFL reconstruction. Multivariate logistic regression found the following variables to be predictors of inpatient admission: age (odds ratio [OR] = 1.03 [95% confidence interval {CI} 1.02-1.04]; P <.001), spinal anesthesia (OR = 3.42 [95% CI 1.98-6.08]; P < .001), American Society of Anesthesiologists (ASA) class 3/4 (OR = 1.96 [95% CI 1.25-3.06]; P < .001), history of chronic obstructive pulmonary disease (COPD) (OR = 6.44 [95% CI 1.58-26.17]; P = .02), and body mass index (BMI) (OR = 1.03 [95% CI 1.01-1.05]; P < .001). The ensemble model achieved the best performance based on discrimination assessed via internal validation (area under the curve = 0.722). The variables determined most important by the ensemble model were increasing BMI, increasing age, ASA class, anesthesia, smoking, hypertension, lateral release, and history of COPD. Conclusions An internally validated machine learning algorithm outperformed logistic regression modeling in predicting the need for unplanned overnight hospitalization after MPFL reconstruction. In this model, the most significant risk factors for admission were age, BMI, ASA class, smoking status, hypertension, lateral release, and history of COPD. This tool can be deployed to augment provider assessment to identify high-risk candidates and appropriately set postoperative expectations for patients. Clinical Relevance Identifying and mitigating patient risk factors to prevent adverse surgical outcomes and hospitalizations is one of our primary goals. There may be a key role for machine learning algorithms to help successfully and efficiently risk stratify patients to decrease costs, appropriately set postoperative expectations, and increase the quality of delivered care.
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Affiliation(s)
- Chimere O Ezuma
- School of Medicine, Vagelos Columbia College of Physicians and Surgeons, New York, New York
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, and Rochester, Minnesota
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Mayo Clinic, and Rochester, Minnesota
| | - Ryan Wilbur
- Department of Orthopedic Surgery, Mayo Clinic, and Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, and Rochester, Minnesota
| | - Brian Forsythe
- Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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15
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Belay ES, Cochrane NH, Anastasio AT, Wu M, Bolognesi MP, Seyler TM. Risk Factors for Delayed Discharge and Adverse Outcomes Following Outpatient Billed Total Knee Arthroplasty. J Arthroplasty 2022; 37:1029-1033. [PMID: 35183711 DOI: 10.1016/j.arth.2022.02.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The volume of outpatient total knee arthroplasty (TKA) has increased with advances in perioperative protocols, patient selection, and recent policy changes regarding insurance authorization. This study analyzed 30-day outcomes from a national database to better understand risk factors for delayed discharge (length of stay [LOS] ≥1), readmission, and reoperation after outpatient TKA. METHODS The National Surgical Quality Improvement Program (NSQIP) database was utilized to collect TKA (CPT 27447) billed as outpatient surgery performed from 2013 to 2018. Patient demographics, comorbidities, and short-term outcomes were collected and compared in LOS 0 versus LOS ≥1 cohorts. Subgroup analysis was completed for TKA performed in 2018, after the Center for Medicare Services removal of TKA from the inpatient-only list. RESULTS A total of 13,669 patients had outpatient TKA performed from 2013 to 2018. Most patients had LOS ≥1 day (77.1%). The LOS 0 cohort demonstrated a lower 30-day readmission rate (1.8%) compared to LOS ≥1 (2.8%), P > .01. Both groups demonstrated a low 30-day reoperation rate, LOS 0 (0.7%) and LOS ≥1 (1.1%), P = .05. Regression analysis demonstrated risk factors for LOS ≥1 day included COPD, ASA ≥3, age >75, and BMI >35 kg/m2. Regression analysis demonstrated male gender, age >75, ASA ≥3, and albumin <3.5 g/dL were risk factors for readmission. Hypertension was a risk factor for 30-day reoperation. CONCLUSION Risk factors for LOS ≥1 day include age >75, ASA ≥3, BMI >35 kg/m2. In addition, BMI >35 kg/m2 was a risk factor for readmission and reoperation. These findings reinforce appropriate patient selection when considering outpatient TKA.
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Affiliation(s)
- Elshaday S Belay
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Albert T Anastasio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Mark Wu
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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16
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Site of service of irrigation and debridement of open finger and hand fractures: a retrospective review of trends and outcomes. CURRENT ORTHOPAEDIC PRACTICE 2022; 33:358-362. [DOI: 10.1097/bco.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Peacock S, Wolfstadt J, Peer M, Gleicher Y. Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative. BMJ Open Qual 2022; 11:bmjoq-2021-001698. [PMID: 35318244 PMCID: PMC8943481 DOI: 10.1136/bmjoq-2021-001698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible option. COVID-19 caused significant constraints on inpatient surgical resources and contributed to a growing surgical backlog. We present a quality improvement (QI) initiative aimed at adding an outpatient TJA pathway to our pre-existing inpatient TJA programme, with the target of performing 25% of our primary TJA as outpatients. Methods This was a QI study at a tertiary level arthroplasty centre. To achieve our aim, a patient-centred needs analysis revealed the need to develop patient selection criteria, perform a specific and tailored anaesthetic, provide patient education and conduct virtual care follow-up. Based on these findings, an outpatient TJA intervention bundle was developed and implemented. Results After implementing the outpatient pathway, 65 patients were scheduled for outpatient TJA. Fifty-five (84.6%) patients were successfully discharged home on the day of surgery. Successful outpatient TJA accounted for 33.3% of all primary TJAs performed at our intuition throughout the study period. There was excellent adherence to the intervention protocols, with the success hinging on multidisciplinary team and supported QI culture. Thirty-day emergency department visits for inpatient and outpatient TJAs were 8.93% and 6.15%, respectively. No outpatient TJA patients required hospital readmission within 30 days. Conclusion Our study demonstrates that implementation of an outpatient TJA pathway in response to inpatient resource constraints during the COVID-19 pandemic is feasible. The findings of this report will be of interest to surgical centres facing surgical backlog and constraints on inpatient resources during and after the pandemic.
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Affiliation(s)
- Sharon Peacock
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Sinai Health System, Toronto, Ontario, Canada
| | - Jesse Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Department of Surgery, Temerty Faculty of Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Sinai Health System, Toronto, Ontario, Canada
| | - Miki Peer
- Department of Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Yehoshua Gleicher
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Sinai Health System, Toronto, Ontario, Canada
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18
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Ding BTK, Ng J, Tan KG. Enhanced Recovery after Surgery for Knee Arthroplasty in the Era of COVID-19. J Knee Surg 2022; 35:424-433. [PMID: 32838454 DOI: 10.1055/s-0040-1715125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Enhanced recovery after surgery (ERAS) represents a paradigm shift in perioperative care, aimed at achieving early recovery for surgical patients, reducing length of hospital stay, and complications. The purpose of this study was to provide an insight of the impact of the COVID-19 on ERAS protocols for knee arthroplasty patients in a tertiary hospital and potential strategy changes for postpandemic practice. We retrospectively reviewed all cases that underwent surgery utilizing ERAS protocols in the quarter prior to the pandemic (fourth quarter of 2019) and during the first quarter of 2020 when the pandemic started. A review of the literature on ERAS protocols for knee arthroplasty during the COVID-19 pandemic was also performed and discussed. A total of 199 knee arthroplasties were performed in fourth quarter of 2019 as compared with 76 in the first quarter of 2020 during the COVID-19 outbreak. Patients who underwent surgery in the first quarter of 2020 had shorter inpatient stays (3.8 vs. 4.5 days), larger percentage of discharges by postoperative day 5 (86.8 vs. 74.9%), and a larger proportion of patients discharged to their own homes (68 vs. 54%). The overall complication rate (1.3 vs. 3%) and readmission within 30 days (2.6 vs. 2%) was similar between both groups. ERAS protocols appear to reduce hospital lengths of stay for patients undergoing knee arthroplasty without increasing the risk of short-term complications and readmissions. The beneficial effects of ERAS appear to be amplified by and are synchronous with the requirements of operating in the era of a pandemic.
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Affiliation(s)
| | - Jensen Ng
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kelvin Guoping Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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19
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Almand J, Pickering T, Parsell D, Stronach B, Carlisle R, McIntyre L. The successful migration of total joint arthroplasty from the hospital inpatient to outpatient ASC setting. Knee 2022; 34:17-23. [PMID: 34871973 DOI: 10.1016/j.knee.2021.11.004] [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: 11/04/2020] [Revised: 06/09/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study was undertaken to analyze the clinical results and complication rate of patients undergoing outpatient total joint arthroplasty by a single orthopedic group. All surgeries were performed in the practice-owned ambulatory surgery center (ASC). METHODS All patients indicated for outpatient total joint arthroplasty from 2016-2019 with complete pre and post-operative patient reported outcomes were enrolled in the study including hip, knee and partial knee replacements. Patient reported outcomes including HOOS, KOOS and VR-12 were collected at six months. Patient complication and satisfaction data was also collected. RESULTS There were 1007 patients enrolled in the study. At six months, THA HOOS and VR-12 scores improved to 82.2 and 54.5/45. TKA KOOS and VR-12 scores improved to an average of 74.3 and 54.0/43.6. At six months, UKA scores improved to an average of 73.6 and 55.1/41.2. All HOOS, KOOS and VR-12 PCS scores improvements were statistically significant (p < 0.001) and met MCID thresholds. A separate cohort of 1898 regionally tracked cases with comprehensive global complication data exhibited 111 complications (unplanned post-operative events generating a medical expense) including manipulation 13 (0.68%), DVT/PE 4 (0.2%), medical 45 (2.4%), wound 8 (0.4%), infection 8 (0.4%). Sixty-six outpatient cases (3.5%) experienced clinical complications requiring some form of additional treatment. CONCLUSION Outpatient joint arthroplasty performed in the ASC is safe and effective in appropriately selected patients with complication rates that compares favorably to inpatient procedures.
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Affiliation(s)
- Jeff Almand
- Mississippi Sports Medicine and Orthopedic Care, United States
| | | | - Doug Parsell
- Mississippi Sports Medicine and Orthopedic Care, United States
| | - Ben Stronach
- University of Mississippi Medical Center, United States
| | - Robert Carlisle
- Mississippi Sports Medicine and Orthopedic Care, United States
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20
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Lovasz G, Aros A, Toth F, Va Faye J, La Malfa M. Introduction of day case hip and knee replacement programme at an inpatient ward is safe and may expedite shortening of hospital stays of traditional arthroplasties. J Orthop Surg Res 2021; 16:585. [PMID: 34635122 PMCID: PMC8504781 DOI: 10.1186/s13018-021-02737-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward. METHODS 200 patients underwent elective, unilateral primary day case total hip (THA, n = 94), total knee (TKA, n = 60) and unicondylar knee replacements (UKA, n = 46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n = 6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period. RESULTS 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5%), urine retention (3%) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. CONCLUSION Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.
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Affiliation(s)
- Gyorgy Lovasz
- Practice Plus Group Hospital Barlborough, 2 Lindrick Way, Barlborough, S43 4XE, Chesterfield, UK.
| | - Attila Aros
- Practice Plus Group Hospital Barlborough, 2 Lindrick Way, Barlborough, S43 4XE, Chesterfield, UK
| | - Ferenc Toth
- Practice Plus Group Hospital Barlborough, 2 Lindrick Way, Barlborough, S43 4XE, Chesterfield, UK
| | - John Va Faye
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Marco La Malfa
- Practice Plus Group Hospital Barlborough, 2 Lindrick Way, Barlborough, S43 4XE, Chesterfield, UK
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21
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Dey S, Gadde R, Sobti A, Macdonald N, Jacob J, Unnithan A. The safety and efficacy of day-case total joint arthroplasty. Ann R Coll Surg Engl 2021; 103:638-644. [PMID: 33851548 DOI: 10.1308/rcsann.2021.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The popularity of day-case arthroplasty has been fuelled by focus on its cost effectiveness for the healthcare system. Safety concerns still remain. The aim of this review was to compare readmission rates after total joint arthroplasty for patients undergoing day-case surgery and for inpatients. METHODS A comprehensive online search of databases was performed for all published articles in the English language evaluating readmission rates after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Seventeen studies were deemed eligible and included in the meta-analysis. RESULTS All studies included in the meta-analysis described readmission rates following THA/TKA. The readmission rate for day-case patients was 1.9% (n=124) whereas for inpatients, it was 2.0% (n=12,399). Compared with inpatient arthroplasty, day-case arthroplasty was associated with lower total readmission rates (odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.63-0.94, p=0.01). Furthermore, day-case surgery conferred a decrease in readmission rates for both THA (1.3% vs 7.0%) and TKA (2.7% vs 4.3%). Moreover, day-case THA and TKA were both associated with a decreased chance of readmission (OR: 0.27, 95% CI: 0.17-0.42, p<0.00001; and OR: 0.55, 95% CI: 0.42-0.72, p<0.00001 respectively). CONCLUSIONS This review emphasises that with a thoughtful, designated protocol and with careful patient selection, day-case arthroplasty is a safe and effective option.
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Affiliation(s)
- S Dey
- Ashford and St Peter's Hospitals NHS Foundation Trust, UK
| | - R Gadde
- Ashford and St Peter's Hospitals NHS Foundation Trust, UK
| | - A Sobti
- Ashford and St Peter's Hospitals NHS Foundation Trust, UK
| | - N Macdonald
- Ashford and St Peter's Hospitals NHS Foundation Trust, UK
| | - J Jacob
- Ashford and St Peter's Hospitals NHS Foundation Trust, UK
| | - A Unnithan
- Ashford and St Peter's Hospitals NHS Foundation Trust, UK
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22
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Brzezinski A, Imbergamo C, Weintraub M, Patankar A, Kayiaros S. Single-Stage Bilateral Total Hip Arthroplasty in an Ambulatory Surgical Center: A Report of Three Cases. Arthroplast Today 2021; 8:74-77. [PMID: 33732830 PMCID: PMC7937532 DOI: 10.1016/j.artd.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/23/2022] Open
Abstract
In recent years, there has been increased interest in transitioning total joint arthroplasty procedures from inpatient settings to ambulatory surgical centers to decrease costs and eliminate the need for hospital stays. In addition, simultaneous bilateral total hip arthroplasty (THA) has been found to be favorable in certain patient populations when compared with staged bilateral THA. In this study, we report the results of a series of three patients who underwent single-stage bilateral THA in a free-standing ambulatory surgical center with excellent short-term outcomes and no 90-day complications.
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Affiliation(s)
| | - Casey Imbergamo
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Aneesh Patankar
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Stephen Kayiaros
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,University Orthopaedic Associates, Somerset, NJ, USA
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