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Safety and outcomes of outpatient compared to inpatient total knee arthroplasty: a national retrospective cohort study
  1. Harry T Mai1,
  2. Taif Mukhdomi1,
  3. Daniel Croxford1,
  4. Patricia Apruzzese2,
  5. Mark C Kendall1 and
  6. Gildasio S De Oliveira1
  1. 1Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  2. 2Anesthesiology, Rhode Island Hospital, Providence, Rhode Island, USA
  1. Correspondence to Dr Gildasio S De Oliveira, Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA; Gildasio.deoliveira{at}lifespan.org

Abstract

Background Many factors are driving total knee arthroplasty to be performed more commonly as an outpatient (<24 hour discharge) procedure. Nonetheless, the safety of total knee replacements performed in the outpatient setting is not well established when compared with inpatient setting. The purpose of this study is to compare the postoperative outcomes of outpatient and inpatient total knee arthroplasties.

Methods The 2015 and 2016 American College of Surgeons National Surgical Quality Improvement Program data sets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty. The primary outcome was serious adverse events defined by a composite outcome including: return to operating room, wound-related infection, thromboembolic event, renal failure, myocardial infarction, cardiac arrest requiring cardiopulmonary resuscitation, cerebrovascular accident, use of ventilator >48 hours, unplanned intubation, sepsis/septic shock, and death. Propensity matched analysis was used to adjust for potential confounding covariates.

Results 1099 patients undergoing outpatient total knee arthroplasty (1% of total cases) were successfully matched to 1099 patients undergoing inpatient surgeries. The composite rate of serious adverse events was greater in outpatient procedures compared with inpatient procedures (3.18% vs 1.36%, p=0.005). In contrast, failure to rescue and readmission rates were not different between groups.

Conclusions Outpatient total knee arthroplasty is associated with a higher composite risk of serious adverse events than inpatient procedures. Anesthesiologists and surgeons should inform patients and discuss this information when obtaining consent for surgery and planning for discharge timing.

  • ambulatory care
  • postoperative complications
  • outcomes
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Footnotes

  • Presented at Presented in part at The American Society of Anesthesiologists Annual Meeting, Orlando, Florida, October 2019.

  • Contributors HTM: This author participated in the study design, conduct of the study, and manuscript preparation. TM: This author participated in the study design, conduct of the study, and manuscript preparation. DC: This author participated in the study design, conduct of the study, and manuscript preparation. PA: This author participated in the study design, conduct of the study, statistical analysis, and manuscript preparation. MCK: This author participated in the study design, conduct of the study, and manuscript preparation. GDO: This author participated in the study design, conduct of the study, statistical analysis, and manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was performed under an exempt status granted by the Institutional Review Board of Rhode Island Hospital (IRB#1531731).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available, https://www.facs.org/quality-programs/acs-nsqip/participant-use.

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