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Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database
Journal article   Peer reviewed

Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database

P Maxwell Courtney, Anthony J Boniello and Richard A Berger
The Journal of arthroplasty, v 32(5), pp 1426-1430
May 2017
DOI: https://doi.org/10.1016/j.arth.2016.11.055
PMID: 28034481
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Aged Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Knee - adverse effects Comorbidity Databases, Factual Female Hospitals Humans Inpatients Male Middle Aged Multivariate Analysis Outpatients Patient Discharge - statistics & numerical data Patient Readmission Postoperative Complications - epidemiology Quality Improvement Reoperation - adverse effects Retrospective Studies Risk Factors
As outpatient total hip (THA) and knee arthroplasties (TKA) increase in popularity, concerns exist about the safety of discharging patients home the same day. The purpose of this study is to determine the complications associated with outpatient total joint arthroplasty (TJA) and to identify high-risk patients who should be excluded from these protocols. We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients who underwent primary TKA or THA from 2011 to 2014. Demographic variables, medical comorbidities, and 30-day complication, readmission, and reoperation rates were compared between outpatient and traditional inpatient procedures. A multivariate logistic regression analysis was then performed to identify independent risk factors of poor short-term outcomes. Of the total 169,406 patients who underwent TJA, 1220 were outpatient (0.7%). The outpatient and inpatient groups had an overall complication rate of 8% and 16%, respectively. Patients aged more than 70 years, those with malnutrition, cardiac history, smoking history, or diabetes mellitus are at higher risk for readmission and complications after THA and TKA (all P < .05). Surprisingly, outpatient TJA alone did not increase the risk of readmission (OR 0.652, 95% CI 0.243-1.746, P = .395) or reoperation (OR 1.168, 95% CI 0.374-3.651, P = .789), and was a negative independent risk factor for complications (OR 0.459, 95% CI 0.371-0.567, P < .001). With the resources available in a hospital setting, outpatient TJA may be a safe option, but only in select, healthier patients. Care should be taken to extrapolate these results to an outpatient facility, where complications may be more difficult to manage.

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210 citations in Web of Science
214 citations in Scopus

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Orthopedics
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