Outpatient Versus Inpatient Total Joint Arthroplasty: Do Medically and Socially Complex Patients Require More Resources but Achieve Similar Outcomes?

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today Pub Date : 2025-02-11 DOI:10.1016/j.artd.2025.101631

Justin Leal BS, Christine J. Wu MD, Niall H. Cochrane MD, Thorsten M. Seyler MD, PhD, William A. Jiranek MD, Samuel S. Wellman MD, Michael P. Bolognesi MD, Sean P. Ryan MD

{"title":"Outpatient Versus Inpatient Total Joint Arthroplasty: Do Medically and Socially Complex Patients Require More Resources but Achieve Similar Outcomes?","authors":"Justin Leal BS, Christine J. Wu MD, Niall H. Cochrane MD, Thorsten M. Seyler MD, PhD, William A. Jiranek MD, Samuel S. Wellman MD, Michael P. Bolognesi MD, Sean P. Ryan MD","doi":"10.1016/j.artd.2025.101631","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>This study compared outcomes between patients undergoing outpatient total joint arthroplasty (TJA) at an ambulatory surgery center (ASC) versus a cohort of medically and socially complex patients undergoing TJA at a tertiary healthcare system.</div></div><div><h3>Methods</h3><div>An institutional database at a single academic center was retrospectively reviewed for patients who underwent primary TJA since the opening of an ASC from August 2021 to January 2024. A total of 716 (outpatient: 374; inpatient: 342) total knee arthroplasties and 458 (outpatient: 196; inpatient: 262) total hip arthroplasties met inclusion criteria.</div></div><div><h3>Results</h3><div>Patients in the inpatient total knee arthroplasty group had a higher proportion of patients requiring an emergency department visit (11.4% vs 4.5%; <em>P =</em> .008) and admission (6.7% vs 2.7%; <em>P =</em> .025) within the first 90 days after surgery than the outpatient group; however, 2-year revision-free (97.9% vs 97.9%; <em>P =</em> .75) survival was similar between groups. Patients in the inpatient total hip arthroplasty group had a higher proportion of patients requiring an emergency department visit (13.0% vs 4.6%; <em>P =</em> .035) and admission (7.3% vs 1.0%; <em>P =</em> .018) within the first 90 days after surgery compared to the outpatient group; however, there was no difference in 2-year revision-free survival (96.4% vs 99.5%; <em>P =</em> .059).</div></div><div><h3>Conclusions</h3><div>Medically and socially complex patients undergoing TJA required additional resources during the 90-day postoperative window; however, they achieved similar survivorship as patients who met criteria for outpatient surgery.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"32 ","pages":"Article 101631"},"PeriodicalIF":1.5000,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroplasty Today","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352344125000184","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

This study compared outcomes between patients undergoing outpatient total joint arthroplasty (TJA) at an ambulatory surgery center (ASC) versus a cohort of medically and socially complex patients undergoing TJA at a tertiary healthcare system.

Methods

An institutional database at a single academic center was retrospectively reviewed for patients who underwent primary TJA since the opening of an ASC from August 2021 to January 2024. A total of 716 (outpatient: 374; inpatient: 342) total knee arthroplasties and 458 (outpatient: 196; inpatient: 262) total hip arthroplasties met inclusion criteria.

Results

Patients in the inpatient total knee arthroplasty group had a higher proportion of patients requiring an emergency department visit (11.4% vs 4.5%; P = .008) and admission (6.7% vs 2.7%; P = .025) within the first 90 days after surgery than the outpatient group; however, 2-year revision-free (97.9% vs 97.9%; P = .75) survival was similar between groups. Patients in the inpatient total hip arthroplasty group had a higher proportion of patients requiring an emergency department visit (13.0% vs 4.6%; P = .035) and admission (7.3% vs 1.0%; P = .018) within the first 90 days after surgery compared to the outpatient group; however, there was no difference in 2-year revision-free survival (96.4% vs 99.5%; P = .059).

Conclusions

Medically and socially complex patients undergoing TJA required additional resources during the 90-day postoperative window; however, they achieved similar survivorship as patients who met criteria for outpatient surgery.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.