Outpatient Total Hip Arthroplasty Has Minimal Short-Term Complications With the Use of Institutional Protocols

Aug 16, 2018The Journal of arthroplasty

Outpatient Total Hip Replacement Has Few Short-Term Problems When Using Standard Hospital Procedures

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Abstract

The outpatient total hip arthroplasty (THA) cohort had a 0.6% 90-day readmission rate compared to 3.6% for the inpatient cohort.

Patients undergoing outpatient SDD THA had a lower average body mass index (26.9 kg/m) compared to inpatient patients (28.2 kg/m).
The outpatient cohort consisted of a higher percentage of Caucasian patients (89.6%) compared to the inpatient group (66.3%).
Patients in the SDD group were exclusively covered by commercial insurance (100%), whereas only 36.3% of the inpatient group had commercial insurance.
The length of stay for outpatient THA was significantly shorter at 0.37 days compared to 2.3 days for inpatient THA.
All patients in the outpatient cohort were discharged home (100%), while 92.6% of inpatient patients were discharged to home.

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BACKGROUND: Interest in outpatient/same-day discharge (SDD) total hip arthroplasty (THA) has been increasing over the last several years. There is considerable debate in the literature regarding the complication and readmission rates of these patients. To evaluate and validate the safety and efficacy of our institutional SDD THA care pathway, we compared the outcomes of patients undergoing SDD THA with patients who had a similar comorbidity profile and underwent inpatient THA.

METHODS: A retrospective review was conducted on 164 patients who underwent SDD THA from January 2015 to September 2016. The Risk of Readmission Tool, a validated risk stratification instrument, was applied to all inpatient THAs performed from June 2014 to December 2016. A cutoff Risk of Readmission Tool score < 3 was used to produce a cohort of 1858 inpatient THA patients, all of whom had a similar risk profile to patients who underwent SDD THA. Medicare patients were excluded from the inpatient THA cohort, which left a final inpatient sample of 1315 patients. Each cohort was evaluated for demographic variables, length of stay, 30-/90-day readmissions, and discharge disposition.

RESULTS: The SDD THA cohort had significantly lower body mass index (26.9 vs 28.2 kg/m; P = .002), had fewer minorities (89.6% vs 66.3% Caucasians; P < .001), was exclusively commercial insurance (100% vs 36.3%), had a shorter length of stay (0.37 vs 2.3 days, P < .001), and was exclusively discharged home (100% vs 92.6%). There was no statistically significant difference in 30-day readmission rates between either cohort (SDD 0.6% vs inpatient 1.6%; P = .325). However, the SDD cohort had a significantly lower rate of 90-day readmissions than the inpatient cohort (0.6% vs 3.6%; P = .014). 2

CONCLUSION: The use of an institutional SDD THA care pathway can produce results with equivalent or better short-term outcomes than that of traditional inpatient THA.

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Outpatient Total Hip Arthroplasty Has Minimal Short-Term Complications With the Use of Institutional Protocols

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