Early experience of an integrated ambulatory care program for joint replacement surgery

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Public Health

Background:

• Rising demand for joint replacements necessitates innovative healthcare models.
• Integrated ambulatory care centres (IACs) are emerging as public-private partnerships to address backlogs.
• Assessing IACs' safety, effectiveness, and sustainability is crucial for healthcare planning.

Purpose of the Study:

• To evaluate the safety and effectiveness of an IAC for hip, knee, and shoulder replacements.
• To compare patient outcomes between an IAC and a traditional public hospital setting.
• To determine the sustainability of the IAC model in improving access to care.

Main Methods:

• Retrospective analysis of 600 arthroplasty patients at an IAC (Feb 2023 - Mar 2024).
• Matched comparison with patients undergoing outpatient surgery at a partner hospital.
• Primary outcome: unexpected emergency department (ED) encounters within 1 week; secondary outcomes: discharge success, reoperation rates, and patient-reported outcome measures (PROMs).

Main Results:

• No significant differences in 7-day ED encounters between IAC and public hospital groups (3% vs. 5%, p=0.2).
• Low rates of reoperation (2 patients, <1%) and 24-hour admission (2 patients, 0.3%) at the IAC.
• Significant improvements in Oxford Hip Score, Oxford Knee Score, and PROMIS physical scores observed in the IAC group.

Conclusions:

• IACs offer a safe and effective model for joint replacement surgery.
• The IAC model successfully improves patient access to care without adverse effects on ED visits or PROMs.
• IACs represent a viable solution for enhancing orthopedic surgical capacity and patient outcomes.