The Shift to Same-Day Outpatient Joint Arthroplasty: A Systematic Review

• Published in: The Journal of arthroplasty 2018-04, Vol.33 (4), p.1265-1274
• Main Authors: Hoffmann, Jeffrey D., Kusnezov, Nicholas A., Dunn, John C., Zarkadis, Nicholas J., Goodman, Gens P., Berger, Richard A.
• Format: Article
• Language: English
• Subjects: arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Emergency Service, Hospital; Humans; Inpatients; outpatient; outpatient arthroplasty; Outpatients; Patient Discharge; Patient Readmission; Postoperative Complications - etiology; Reoperation - adverse effects; total hip arthroplasty; total knee arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.11.027

Hip and knee arthroplasties length of stay continues to shorten after advances in perioperative and intraoperative management, as well as financial incentives. Some authors have demonstrated good results with outpatient arthroplasty, but safety and general feasibility of such procedures remain unclear. Our hypothesis is that outpatient arthroplasty would demonstrate higher readmission and complication rates than inpatient arthroplasty. We performed a systematic review of all publications on outpatient arthroplasty between January 1, 2000 and June 1, 2016. Included publications had to demonstrate a specific outpatient protocol and have reported perioperative complications and unplanned readmissions. Patient demographics, surgical variables, and protocol details were recorded in addition to complications, readmission, and reoperation. Ten manuscripts accounting for 1009 patients demonstrated that 955 (94.7%) were discharged the same day as planned, with the majority of failures to discharge being secondary to pain, hypotension, and nausea. There were no deaths and only 1 major complication. Only 20 patients (1.98%) required reoperation and 20 (1.98%) had readmission or visited the emergency room within 90 days of their operation. In the 2 series recording patient outcomes, 80% and 96% of patients reported that they would choose to undergo outpatient arthroplasty again. For carefully selected patients with experienced surgeons in major centers, outpatient arthroplasty may be a safe and effective procedure. Although our data is promising, further study is required to better elucidate the differences between inpatient and outpatient arthroplasty outcomes.