Due to the increasing number of outpatient hip and knee replacements, Geoffrey Westrich, MD and colleagues at the Hospital for Special Surgery (HSS) analyzed trends in patients who returned home and spent the same day after surgery. We have started a study comparing complication rates. Over 1 night at the hospital.
Analyzing information from a large database of patients across the country, the researchers found Hospital readmission For total hip arthroplasty for outpatients.total knees Instead, they found slightly higher odds of complications for patients discharged on the day they had. Surgery..The study appeared online before printing Journal of arthroplasty.
“In recent years, there has been increasing interest in shifts among surgeons and hospital systems. Joint replacement Dr. Westrich, Honorary Research Director of HSS’s Adult Reconstruction and Joint Replacement Services, said, “We go to outpatient centers safely and efficiently, but data on trends, comorbidities, and complications of patients discharged on the same day. Is limited. Surgery. “
Using the PearlDiver Mariner database, Dr. Westrich and colleagues identified approximately 1.8 million patients who underwent primary total hip or knee replacement between 2010 and 2017. Inpatient or outpatient base. For each group, researchers collected patient demographics, complications, and complications within 90 days of surgery requiring readmission to the hospital.
Researchers found that the annual prevalence of outpatient hip and knee replacements increased exponentially from 2010 to 2017, with 15.8% in the hip replacement group and 11.1 in the outpatient knee replacement group. Shows an average annual change of%. Overall, the patients discharged on the day of surgery were young and healthy, with few medical conditions such as diabetes and chronic lung disease.
For hip arthroplasty patients, there was no significant difference in complications requiring readmission within 90 days, whether surgery was performed outpatient or inpatient. Patients with total knee arthroplasty who were discharged on the same day had slightly higher odds ratios for complications requiring readmission. Overall, complications were uncommon in both knee replacement groups, with an incidence of less than 1%.
The authors of the study believe that same-day discharge joint replacement is safe, but show that additional patient monitoring is needed early after surgery. Dr. Westrich emphasizes the importance of selecting patients to ensure best results, and that good general health is essential for anyone considering joint replacement in outpatients. I am saying. People with heart or lung disease, diabetes, or sleep apnea are not eligible. They must be non-smokers. Young patients in their 40s or 50s and 60s tend to be better candidates, but people in their early 70s who are in very good general health may also be eligible.
“Persons considering leaving the hospital on the day should feel comfortable spending the night in the hospital they receive care of,” Dr. Westrich added. “Patients who are very worried about surgery or who are experiencing great stress in recovery may not be good candidates.”
Dr. Westrich said the transition to outpatient joint replacement is marked by the introduction of a lump sum payment improvement (BPCI) by the Medicare and Medicaid Service Centers (CMS), encouraging unnecessary hospital-related cost and duration reductions. It states that it is doing. Of stay.
“Our study aimed to reinforce the literature on outpatient joint replacement so that orthopedists and their patients can make informed decisions,” he says. “We have found that it can be done safely and efficiently, but this is optional and not mandatory. Patients are different, individuals and their doctors Informed decisions It is based on what the patient feels most comfortable with. ”
Eytan M. Debbi et al, same day discharge total hip arthroplasty: trends, complications, and readmission rates, Arthroplasty Journal (2021). DOI: 10.1016 / j.arth.2021.11.023
Special Surgery Hospital
Quote: In the study, with hospitalization (January 14, 2022) obtained from https: //medicalxpress.com/news/2022-01-explores-trends-outcomes-outpatient-joint.html on January 14, 2022. We are investigating the trends and results of comparative outpatient joint replacement surgery.
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