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Is Outpatient Arthroplasty Safe? A Systematic Review
Monketh Jaibaji1, Andrea Volpin2, Fares S Haddad1
1Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
The Journal of Arthroplasty
|March 21, 2020
Summary
Outpatient hip and knee replacements show low readmission rates (2.3%) and high same-day discharge success (93.4%). Patients selected were healthier, but more research is needed on optimal protocols for outpatient arthroplasty safety.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Perioperative Care
Background:
- Reduced hospital stays in lower limb arthroplasty due to improved perioperative care and bed demand.
- Demographic and fiscal trends also influence shorter hospitalizations.
- Outpatient hip and knee arthroplasty shows promise, but safety and optimal protocols require further investigation.
Purpose of the Study:
- To systematically review complication and reoperation rates for outpatient hip and knee arthroplasty.
- To assess the safety and efficacy of same-day discharge protocols.
- To identify patient selection criteria and reasons for failed discharges.
Main Methods:
- Systematic review of studies published between January 1, 2009, and November 1, 2019.
- Analysis of 30 and/or 90-day complication rates for outpatient total hip, total knee, and unicondylar knee arthroplasty.
- Extraction of patient demographics, anesthesia, analgesic protocols, selection criteria, and discharge failure reasons.
Main Results:
- Nineteen manuscripts analyzed, encompassing 6519 procedures.
- Mean 90-day readmission rate was 2.3% (0%-6%), with an overall complication rate of 1.61% (0%-4%).
- Successful same-day discharge rate was 93.4%; nausea/dizziness was the most common reason for discharge failure.
Conclusions:
- Outpatient arthroplasty patients were generally younger, more active, and had fewer comorbidities.
- Significant variations in reported complications exist across studies.
- Further research is essential to confirm outpatient program outcomes against fast-track programs and establish optimal perioperative protocols.
