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Outpatient total elbow arthroplasty-outcomes and complications: a systematic review and meta-analysis
Vishwajeet Singh1, Naadir Nazar2, Lowilius Wiyono3
1Trust Grade Orthopaedic Registrar, Department of Trauma & Orthopaedics, Barts Health NHS Trust, London, UK.
Background:
Total elbow arthroplasty (TEA) is a surgical procedure used in the management of arthritis and fractures. Outpatient total elbow arthroplasty (OTEA) could be a valid option to reduce workforce burden and cost, provided it can be proven to be equally safe and effective as inpatient TEA. This meta-analysis was conducted to evaluate the efficacy and safety of OTEA.
Methods:
A literature search was performed in PubMed, Embase, Scopus, and Google Scholar using DistillerSR, with predetermined keywords based on the Patient/Problem, Intervention, Control, and Outcome criteria. Studies characterizing OTEA and/or inpatient TEA were included. Total readmissions, revision rates, cost difference, and functional outcome scores were assessed for outpatient vs. inpatient TEA. Risk of bias assessment was performed using the Risk of Bias in Nonrandomized Studies of Interventions tool.
Results:
Five studies fulfilled the inclusion criteria. Seven hundred twenty-five patients in the outpatient group and 1,461 patients in the inpatient group (control). Incidence of complications was significantly higher in the inpatient cohort compared to the outpatient TEAs (inpatient n = 121 (%) vs. outpatient n = 51 (%), P = .037) Readmissions occurred in 84/1,166 cases (7%). There was no significant difference in the readmission rate between the inpatient (57/745, 7%) and the outpatient (27/421, 6%). The cost of OTEA was lower than inpatient TEA, with a mean of 26, 817 USD in the inpatient group when compared to 18,412 USD for OTEA.
Discussion:
Clinical results of outpatient vs. inpatient TEA were similar with respect to overall complications, readmissions, and functional scores, and outpatient TEA was more cost effective. Our review indicates that outpatient TEA can be considered by individual care providers after development of appropriate local pathways. This review highlights the need for further high-quality studies in this niche but clinically important field.
