Assessment of 90-Day Outcomes Following Total Joint Arthroplasty in Ambulatory Surgery Centers, Hospital Outpatient Departments, and Hospitals: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today Pub Date : 2025-03-08 DOI:10.1016/j.artd.2025.101659

Simarjeet Puri MD , Martin Weaver MD , Lisheng Chen PhD , Tae Kim MHSA , Elizabeth Dailey MD , David C. Markel MD

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引用次数: 0

Abstract

Background

Total joint arthroplasty is shifting from hospitals to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). A Michigan Arthroplasty Registry Quality Collaborative Initiative quality improvement project examined readmissions, emergency room (ER) visits, periprosthetic joint infection (PJI), fracture, and dislocation after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) across sites.

Methods

Primary TJAs between July 1, 2021, and June 30, 2022 (N = 41,696: 3910 ASC, 1,834 HOPD, and 35,952 hospital) were reviewed. Of 17,100 THAs, 9.5% (1,631) were at ASCs, 4.7% (798) at HOPDs, and 85.8% (14,671) at hospitals. Of 24,596 TKAs, 9.3% (2,279) were at ASC, 4.2% (1,036) at HOPDs, and 86.5% (21,281) at hospitals. Hospitals treated more elderly, women, non-White, obese, diabetics, smokers, and governmental insurance.

Results

For THAs, ASCs had the lowest 30-day (ASC 1%, HOPD 1.8%, hospital 3.4%, P < .001) and 90-day (ASC 1.7%, HOPD 3.4%, hospital 5.5%, P < .001) readmissions, 30-day ER visits (ASC 1.8%, HOPD 3.5%, hospital 5.3%, P < .001), and fractures (ASC 0.4%, HOPD 0.6%, hospital 1.2%, P < .001). Similar trends were observed for TKAs: 30-day readmissions (ASC 1.3%, HOPD 1.4%, hospital 3.1%, P < .001), 90-day readmissions (ASC 2.2%, HOPD 2.3%, hospital 5.2%, P < .001), and 30-day ER visits (ASC 3%, HOPD 6.5%, hospital 6.4%, P < .001). PJI (THA: P = .1, TKA: P = .6) and dislocation rates (P = .5) were similar across sites.

Conclusions

Patients receiving primary total joint arthroplasty at an ASC had the least postoperative hospital-based care despite similar rates of PJI and dislocation.

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在门诊手术中心、医院门诊部和医院进行全关节置换术后90天的疗效评估：一项密歇根关节置换术注册中心协作质量倡议分析

背景：全关节置换术正从医院转移到门诊手术中心（ASCs）和医院门诊部（HOPDs）。密歇根关节置换术登记处质量协作倡议质量改进项目检查了各部位原发性全髋关节置换术（THA）或全膝关节置换术（TKA）后再入院、急诊室（ER）就诊、假体周围关节感染（PJI）、骨折和脱位。方法回顾性分析2021年7月1日至2022年6月30日期间的初级TJAs （N = 41696例：ASC 3910例，HOPD 1834例，35952家医院）。在17,100例tha中，9.5%（1,631例）在ASCs， 4.7%（798例）在hopd， 85.8%（14,671例）在医院。在24,596名tka中，9.3%（2,279名）在ASC， 4.2%（1,036名）在hopd， 86.5%（21,281名）在医院。医院治疗的老年人、妇女、非白人、肥胖、糖尿病患者、吸烟者和政府保险患者更多。结果30天ASC最低(ASC 1%, HOPD 1.8%，医院3.4%,P <；.001)和90天(ASC 1.7%, HOPD 3.4%，医院5.5%,P <；.001)再入院，30天急诊室就诊(ASC 1.8%, HOPD 3.5%，医院5.3%,P <；.001)，骨折(ASC 0.4%, HOPD 0.6%，医院1.2%,P <；措施)。tka中也观察到类似的趋势：30天再入院(ASC 1.3%, HOPD 1.4%，住院3.1%,P <；.001)， 90天再入院(ASC 2.2%, HOPD 2.3%，医院5.2%,P <；.001)， 30天急诊室就诊(ASC 3%, HOPD 6.5%，医院6.4%,P <；措施)。PJI （THA: P = 0.1, TKA: P = 0.6）和脱位率（P = 0.5）在不同部位相似。结论在ASC接受首次全关节置换术的患者术后住院护理最少，尽管PJI和脱位的发生率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.