Preoperative Patient-Reported Outcomes Predict Candidacy for Outpatient Total Knee Arthroplasty

Area of Science:

• Orthopaedic Surgery
• Patient Outcomes Research
• Health Services Research

Background:

• Total knee arthroplasty (TKA) for end-stage osteoarthritis is increasingly common.
• A growing trend towards outpatient TKA necessitates refined patient selection.
• Preoperative assessment tools are crucial for optimizing outcomes in ambulatory TKA.

Purpose of the Study:

• To evaluate the predictive value of preoperative patient-reported outcome measures (PROMs) for outpatient TKA success.
• To determine if the Brief Resilience Scale (BRS) can identify patients at risk for adverse outcomes.
• To assess the utility of PROMs in guiding patient selection for ambulatory TKA.

Main Methods:

• Retrospective analysis of 2,167 patients undergoing elective primary unilateral TKA.
• Collection of preoperative PROMs: BRS, KOOS, JR, PROMIS-10, RAPT.
• Stratification of patients into low, average, and high resilience groups based on BRS scores.
• Analysis of length of stay (LOS), discharge disposition, and complications using logistic regression and ROC curves.

Main Results:

• Patients with low resilience (BRS < 3) showed significantly higher rates of discharge to a skilled nursing facility (SNF) and extended LOS.
• BRS, RAPT, and PROMIS-10 scores were significant predictors of extended LOS and SNF discharge.
• A combined model accurately predicted extended LOS and SNF discharge with 82.4% sensitivity and 79.9% specificity.

Conclusions:

• Preoperative PROMs, particularly BRS, are valuable for predicting total knee arthroplasty (TKA) failure in the outpatient setting.
• Integrating PROMs into presurgical decision-making can improve patient selection for ambulatory procedures.
• Further prospective studies are needed to validate these findings and explore resilience modification strategies.