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Knee Osteotomies Can Be Performed Safely In An Ambulatory Setting.

Michael Doran¹, Anthony A Essilfie¹, Eoghan T Hurley¹

¹New York University Langone Health, Department of Orthopaedic Surgery, New York, New York, U.S.A.

Arthroscopy, Sports Medicine, and Rehabilitation

|August 29, 2022

Summary

Osteotomies about the knee, including tibial tubercle osteotomies (TTO), high tibial osteotomies (HTO), and distal femoral osteotomies (DFO), can be safely performed in an ambulatory surgery center (ASC) setting with no increase in complications compared to inpatient facilities.

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Area of Science:

Orthopedic Surgery
Surgical Outcomes
Health Services Research

Background:

Ambulatory surgery centers (ASCs) are increasingly utilized for orthopedic procedures.
The safety and efficacy of performing osteotomies about the knee in an ASC setting compared to traditional inpatient facilities require thorough evaluation.

Purpose of the Study:

To compare the rates of hospital admissions, inpatient conversions, reoperations, and complications for tibial tubercle osteotomies (TTO), high tibial osteotomies (HTO), and distal femoral osteotomies (DFO) performed in an ASC versus an inpatient hospital.
To determine the safety and feasibility of outpatient osteotomy procedures.

Main Methods:

A retrospective review of 531 patients undergoing TTO, HTO, or DFO between June 2011 and October 2019.
Exclusion criteria included revision osteotomies, acute fracture repairs, ASA > 3, and BMI > 40.
Statistical analysis using Fisher's exact test and independent samples t-test to compare complication rates between ASC and hospital groups (P < 0.05 considered significant).

Main Results:

No patients undergoing ASC procedures required transfer to an inpatient setting.
No significant differences were observed in overall complication rates (4.1% vs. 4.9%), readmission rates (3.1% vs. 4.5%), or reoperation rates (3.1% vs. 4.5%) between ASC and hospital groups.
Specific complications such as surgical site infection (1.4% vs. 2.6%) and arthrofibrosis (1.4% vs. 1%) also showed no significant difference between the two settings.

Conclusions:

Osteotomies about the knee can be safely performed in an ambulatory surgery center setting.
Outpatient osteotomy procedures demonstrate comparable safety profiles to inpatient procedures regarding complications, readmissions, and reoperations.
The findings support the use of ASCs for selected osteotomy procedures, potentially improving healthcare efficiency and patient access.