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Published on: September 7, 2022
Outpatient Total Hip and Knee Arthroplasty Performed in a Safety Net Hospital System
Robert Daniel Kay1, Adam James Taylor, Erik Yeh Tye
1From the Rancho Los Amigos National Rehabilitation Center, Department of Surgery-Surgical Arthritis, Downey, CA (Dr. Kay, Dr. Taylor, Dr. Tye, Dr. Bryman, and Dr. Runner), and the Department of Orthopaedic Surgery, Medical Center, Harbor-University of California, Los Angeles, CA (Dr. Kay, Dr. Taylor, Dr. Tye, and Dr. Bryman).
Introduction:
High-percentage outpatient total joint arthroplasty (TJA) performed in a safety net hospital system has not been described. A rapid recovery protocol (RRP) was instituted at our safety net hospital that allowed eventual transition to outpatient TJA.
Methods:
Retrospective review of all primary total knee and hip arthroplasty performed by a single surgeon (RR) using an RRP was performed. The initial cohort of patients was monitored overnight with the goal of next-day discharge (n = 57), and as the RRP evolved, the subsequent cohort of patients had the possibility of same-day discharge (PSDD, n = 61). Outcome measures included the rate of same-day discharge in the PSDD cohort and short-term adverse event rates.
Results:
In the PSDD cohort, 86.9% (n = 53) of patients were successfully discharged on the day of surgery, and hospital length of stay was decreased by 17.7 hours (13.5 versus 31.2 hours, P < 0.0001). Comparing the next-day discharge and PSDD groups, no significant differences were found in 30-day emergency department visits (5.3% versus 3.3%, P = 0.67), 90-day complications (15.8% versus 13.1%, P = 0.79), 90-day readmissions (0% versus 3.3%, P = 0.50), or 90-day revision surgeries (0% versus 3.3%, P = 0.50).
Conclusions:
This study demonstrates that the transition to outpatient TJA can be successfully performed in a safety net hospital system without increasing short-term adverse events.
