The Shift to Outpatient Total Hip and Knee Arthroplasty: Perioperative Work Has Not Changed
Hunter Warwick1, Neeku Salehi1, David N Kugelman1
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Background:
Total hip arthroplasty (THA) and knee arthroplasty (TKA) are increasingly being performed on an outpatient basis. With this shift in site of service, the volume and complexity of work required for these procedures may be affected. The purpose of this study was to quantify the amount of perioperative work performed by the surgeon and advanced practice providers for same-day THA and TKA.
Methods:
We prospectively timed preservice, immediate postservice, and discharge coordination activities for a consecutive series of 96 outpatient cases over a 4-week period. Timing data for activities performed in the operating room were obtained retrospectively from our institutional electronic medical record for 500 patients who underwent THA and 500 who underwent TKA. Results were compared with the current approved values reviewed by the Relative Value Scale Update Committee (RUC) in 2019. Cases were also separated into those performed in tertiary care hospitals, specialty hospitals, and ambulatory surgical centers to compare perioperative work by surgical setting.
Results:
The average pre-evaluation time was 43.9 ± 7.3 minutes. The average time from the patient entering the operating room to incision was 39.0 ± 9.8 minutes. Immediate post-service tasks took 26.6 ± 7.2 minutes, and discharge coordination tasks took 122.1 ± 33.9 minutes. Overall, tasks measured took 231.6 minutes and were allotted only 208 minutes by the 2019 RUC. All phases of perioperative work took longer at ambulatory surgical centers relative to other settings, particularly discharge coordination, which took an average of 140.3 minutes (P = 0.043).
Conclusion:
Outpatient arthroplasty requires at least the same amount of perioperative work as traditional inpatient arthroplasty. Further, our results suggest surgical teams are doing more work than is currently valued by the RUC. Policymakers should take this information into consideration while evaluating TKA and THA as these procedures continue to move to the outpatient setting.
