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

To address the increasing demand and backlog of joint replacements, integrated ambulatory care centres (IACs) are being introduced as a public-private partnership in certain areas of Canada. We sought to assess the safety, effectiveness, and sustainability of an IAC for performing hip, knee, and shoulder replacements and to compare patient outcomes between an IAC and a public hospital.

We conducted a retrospective analysis of patients who underwent elective arthroplasty surgery at an IAC between Feb. 1, 2023, and Mar. 28, 2024. We matched patients on age, body mass index (BMI), and sex to patients having outpatient surgery at a partner hospital during that same period. The primary outcome was unexpected emergency department (ED) encounters within 1 week of surgery. Secondary outcomes included failure to discharge on the day of surgery, 90-day reoperation rate, and patient-reported outcome measures (PROMs), including the Oxford Hip Score (OHS), Oxford Knee Score (OKS), and Patient-Reported Outcome Measurement Information System (PROMIS) scores.

We included 600 patients who underwent arthroplasty procedures at an IAC (282 hips, 282 knees, and 36 shoulders). The cohort included 318 females and 282 males, with a mean age of 66 years and a mean BMI of 28.7. Of the 600 patients, 16 (2.7%) had an unexpected ED encounter within 7 days, with 2 (0.3%) patients requiring 24-hour admission. At 90 days, 2 (< 1%) patients required admission for reoperation. In the matched cohort of 234 patients, there were no significant differences in unexpected ED encounters at 7 days (3% for IAC v. 5% for public hospital, p = 0.2). The mean improvement in OHS, OKS, and PROMIS (physical) scores was 17.6 (standard deviation [SD] 10.7), 13.1 (SD 11.2), and 8.8 (SD 7.3), respectively, in the IAC group, and 16.1 (SD 12.7), 8.5 (SD 8.9), and 6.2 (SD 7.0), respectively, in the public hospital group.

An IAC for joint replacement is a safe and effective model of improving access for patients requiring joint replacement surgery, with no negative effect on subsequent ED encounters or patient-reported outcomes.