Safety Considerations for Outpatient Arthroplasty.

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Health Services Research

Background:

• Outpatient total joint arthroplasty (TJA) has seen a significant rise since 2018.
• Surgeons and anesthesiologists must understand the safety implications and patient risk factors associated with outpatient TJAs.

Purpose of the Study:

• To review the safety profile of outpatient total joint arthroplasty.
• To identify critical patient selection criteria and optimization strategies for successful outpatient TJA programs.

Main Methods:

• Analysis of large database studies comparing outpatient and inpatient arthroplasty outcomes.
• Review of potential patient exclusion criteria for outpatient TJA.
• Discussion of patient optimization pre-surgery.

Main Results:

• While smaller studies suggest equivalent risks, larger analyses indicate a potential increase in surgical or medical complications for outpatient TJA patients, even with matched comorbidities.
• Key exclusion criteria for outpatient TJA may include advanced age (>75), bleeding disorders, history of deep vein thrombosis, uncontrolled diabetes, and hypoalbuminemia.
• The comparative risks of same-day versus next-day discharge remain largely unelucidated.

Conclusions:

• Appropriate patient selection is paramount for the success of outpatient arthroplasty programs.
• Further research is needed to fully understand the risks associated with different discharge timings in outpatient TJA.
• Optimizing patient health before surgery is essential for mitigating risks in outpatient joint replacement procedures.