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

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

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 sing...

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Main 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
Format: Article
Language:English
Published: Elsevier 2025-04-01
Series:Arthroplasty Today
Subjects:
Outpatient arthroplasty
Inpatient arthroplasty
Ambulatory surgery center
Bundled payments
Patient-reported outcome measures
Online Access:http://www.sciencedirect.com/science/article/pii/S2352344125000184
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Summary: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.
ISSN:2352-3441

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