Total Hip Surgical Approach Efficiency Outside of Surgical Time in the Ambulatory Surgical Center
George N Guild1, Thomas L Bradbury1, Neal Huang1
1LLC, Advanced Center for Joint Surgery and Northside Hospital Forsyth, Cumming, Georgia.
Background:
Rising demand for total hip arthroplasty (THA) in ambulatory surgery centers (ASCs) requires improved efficiency, considering varying surgical approach time requirements, to manage caseloads and ensure safe same-day discharge (SDD). This study examines care phase durations, SDD success and delays, and outcomes, including 90-day complication rates and 1-year patient-reported outcomes (PROs).
Methods:
A retrospective review of primary THA patients at a single ASC (January 2019 to January 2021) was conducted. Data on demographics, phase-of-care times, perioperative outcomes, 90-day complications, and PROs were stratified by surgical approach. Comparison was done using 2-tailed t-test and Fisher exact test. Stepwise regression controlled for age, gender, body mass index, assistive device use, class attendance, American Society of Anesthesia score, Charlson comorbidity index, and diagnosis.
Results:
Groups differed in age, BMI, assistive device use, class attendance, and preoperative Veterans Rand 12-Item Health Survey physical component scores. The direct anterior approach (DAA) and posterior approach (PA) cohorts showed significant differences in phase-of-care times, except for spinal-time, and total-physical therapy (PT)-time-in-postanesthesia care unit (PACU). DAA was faster in spinal-start-to-incision-time (26.8 versus 35.0; P < 0.001), set-up/take-down-time (20.5 versus 30.2; P < 0.001), operative time (OR; 37.5 versus 50.4; P < 0.001), total operating room time (57.8 versus 80.5; P < 0.001), and arrival-to-discharge-time (383.8 versus 418.4; P < 0.001). PA was faster in time-to-initiation-of-PT (46.3 versus 71.4; P < 0.001), PACU-arrival-to-PT-cleared-time (124.9 versus 144.3; P < 0.001), and total-PACU-time (127.8 versus 143.4; P < 0.001). Surgical approach, age, BMI, and preoperative assistive device use predicted time differences. Excessive spinal was the main cause of PT delays. No differences in 90-day complications or PROs were observed.
Conclusions:
DAA showed shorter total OR and arrival-to-discharge-times compared to PA, with similar complications and PROs. Both approaches effectively achieved SDD. Operative and set-up/take-down-time drove DAA efficiency, but PT initiation was delayed due to standard spinal blocks with shorter OR times.
