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Same-Day Discharge Periacetabular Osteotomy: A Matched Cohort Analysis
Alexandra Marshall1, Ariane Parisien2, Reza Ojaghi1
1Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Insights
Same-day discharge (SDD) for periacetabular osteotomy (PAO) in young hip dysplasia patients is safe and effective. Optimizing patient care can help expand outpatient PAO programs.
Area of Science:
- Orthopedic Surgery
- Hip Dysplasia Treatment
- Surgical Outcomes
Background:
- Hip dysplasia treatment access is limited by healthcare resources.
- Same-day discharge (SDD) for periacetabular osteotomy (PAO) was evaluated.
- This study assessed SDD PAO safety and effectiveness in young patients.
Purpose of the Study:
- To evaluate the safety and effectiveness of same-day discharge (SDD) periacetabular osteotomy (PAO).
- To compare outcomes of SDD PAO with traditional inpatient procedures.
- To identify factors for successful outpatient PAO programs.
Main Methods:
- 59 patients underwent SDD PAO; 47 were matched with inpatients.
- Patients received general anesthesia and multimodal pain management.
- Outcomes included emergency revisits, readmissions, and adverse events.
Main Results:
- 12.8% of SDD patients required extended hospitalization.
- Readmission and emergency department revisit rates were similar between SDD and inpatient groups.
- Adverse events were comparable, with one wound dehiscence and one bleed in each group.
Conclusions:
- Same-day discharge periacetabular osteotomy (PAO) demonstrates comparable safety to inpatient procedures.
- Optimizing patient education and perioperative management is key for successful SDD PAO.
- SDD PAO can help improve access to care for hip dysplasia patients.
Background:
Timely access for young patients who have hip dysplasia can be challenging due to health system resource limitations such as operating room access and hospital beds. This study evaluated the safety and effectiveness of same-day discharge (SDD) periacetabular osteotomy (PAO).
Methods:
There were 59 consecutive patients (mean age 30 years; range, 17 to 50; 60% women) scheduled for SDD. There were 47 outpatients matched with 47 inpatients based on age and a body mass index (BMI). Outpatients had a mean age of 28 years (range, 17 to 46) and BMI of 25.6 (range, 18.9 to 37.1), compared to inpatients between 2015 and 2020 (mean age 28 years, range, 16 to 44; BMI 25.9, range, 19.4 to 34.7). All patients received general anesthesia with multimodal pain management. In the outpatient group, 46.8% had adjunct procedures, compared to 34.0% in the inpatient group. Outcomes included revisits to the emergency department, readmissions, and adverse events (using the modified Sink Dindo Classification).
Results:
There were six outpatients (12.8%) who stayed in the hospital for more than 24 hours, with three planned and three having failed to be discharged the same day, averaging a length of stay of 10.1 hours (range, 5.7 to 23.8). The mean length of stay for inpatients was 3.03 days (range, 1.03 to 11.8). None of the unmatched patients had an SDD. Mean outpatient blood loss was 523 mL (range, 200 to 900), and surgery time was 111.9 minutes (range, 70.8 to 169.2), compared to 643 mL (range, 200 to 1,500) and 121.2 minutes (range, 75 to 259.8) for inpatients. There were two outpatients and three inpatients who returned to the emergency department within seven days. At 90 days, both groups had one readmission: a patient who had a wound dehiscence requiring irrigation and debridement and a patient who had an inferior epigastric bleed requiring embolization in outpatient and inpatient groups, respectively.
Conclusions:
Early experience with SDD PAOs shows comparable safety to inpatient PAOs. Optimizing patient education and perioperative management will help facilitate outpatient PAO programs in other centers.
