Perioperative Differences Between Outpatient and Inpatient Pathways Following Hip and Knee Arthroplasty

Area of Science:

• Orthopedic Surgery
• Arthroplasty Protocols
• Healthcare Logistics

Background:

• Outpatient joint arthroplasty (hip and knee) is increasingly adopted due to optimized clinical pathways and logistics.
• Limited understanding exists regarding the specific protocols and variations between outpatient and traditional inpatient joint arthroplasty procedures.
• This study investigates preoperative, intraoperative, and postoperative differences between outpatient and inpatient hip and knee arthroplasty pathways.

Purpose of the Study:

• To identify and compare preoperative, intraoperative, and postoperative protocol differences between outpatient and inpatient hip and knee arthroplasty.
• To understand the current practices and variations in care delivery for same-day versus traditional inpatient joint replacement surgery.

Main Methods:

• A questionnaire was developed (23-37 items) and distributed via email to orthopedic surgeons.
• The study targeted members of the Dutch Hip Society and Dutch Knee Society.
• A survey response rate of 38% (N=117) was achieved.

Main Results:

• No significant preoperative pathway differences were observed.
• Significant differences in tranexamic acid administration (P < .001 for hip, P = .002 for knee) and perioperative antibiotic prophylaxis (P < .001 for hip, P = .014 for knee) were noted, with outpatient pathways favoring combined regimens and fewer antibiotic doses.
• Same-day postoperative mobilization was less frequent in inpatient hip arthroplasty (24%, P = .034) when surgery occurred later in the day. Postoperative hemoglobin checks were more often indicated in outpatient pathways (∼75% vs. ∼25%, P = .001).

Conclusions:

• Few intraoperative and postoperative differences exist between outpatient and inpatient arthroplasty pathways, largely attributable to logistical factors.
• Outpatient arthroplasty pathways appear to be more contemporary and innovative compared to inpatient protocols.
• The study highlights subtle yet significant variations in medication management and patient mobilization between the two care settings.