Total Joint Arthroplasty at a Novel “Hyperspecialty” Ambulatory Surgical Center With Extended Care Suites is as Safe as Inpatient Arthroplasty
Background: New “hyperspecialty” ambulatory surgical centers (HASCs) have been introduced to deliver safe and cost-efficient care, allowing patients to spend additional nights in an extended care suite before discharge. This study compared the 90-day complications and readmissions of total joint art...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-08-01
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| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344122001182 |
| _version_ | 1811297385132851200 |
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| author | Graham S. Goh, MD Taylor D’Amore, MD P. Maxwell Courtney, MD William J. Hozack, MD Chad A. Krueger, MD |
| author_facet | Graham S. Goh, MD Taylor D’Amore, MD P. Maxwell Courtney, MD William J. Hozack, MD Chad A. Krueger, MD |
| author_sort | Graham S. Goh, MD |
| collection | DOAJ |
| description | Background: New “hyperspecialty” ambulatory surgical centers (HASCs) have been introduced to deliver safe and cost-efficient care, allowing patients to spend additional nights in an extended care suite before discharge. This study compared the 90-day complications and readmissions of total joint arthroplasty (TJA) at an HASC and inpatient TJA at a tertiary hospital. Methods: We retrospectively reviewed 1365 primary, unilateral, TJAs (658 total hip arthroplasty, 707 total knee arthroplasty) performed at 4 HASCs in 2017-2021. Following their outpatient procedure, patients were discharged to an extended care suite staffed full-time by nurses and physical therapists. These patients were matched 1:1 with 1365 inpatient TJAs (628 total hip arthroplasty, 737 total knee arthroplasty) based on demographics, joint, and American Society of Anesthesiologists (ASA) score. Ninety-day complications and readmissions were compared. Results: The mean age was 60.0 ± 9.8 years and 59.4 ± 8.1 years in the inpatient and outpatient groups, respectively (P = .106). There was no difference in ASA≥3 patients (16.4% vs 17.7%; P = .387) and operative time (86.9 ± 31.8 vs 88.7 ± 27.9 minutes; P = .118). Five patients (0.4%) in the outpatient group were transferred to an acute hospital. When comparing 90-day outcomes between the inpatient and outpatient groups, there was no difference in pulmonary embolism (0.1% vs 0.0%; P = .317), mechanical complications (0.3% vs 0.7%; P = .165), periprosthetic joint infections (0.5% vs 1.1%; P = .092), or readmissions (1.2% vs 1.5%; P = .513). A subgroup analysis of ASA≥3 patients yielded similar findings. Conclusions: Patients undergoing outpatient TJA at a novel HASC had similar complication and readmission rates as those undergoing TJA at a tertiary hospital. Based on these data, such facilities seem appropriate for the care of outpatient TJA patients with ASA<4. |
| first_indexed | 2024-04-13T06:03:26Z |
| format | Article |
| id | doaj.art-9e98dc668394404b907323d9d8d28bc7 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-04-13T06:03:26Z |
| publishDate | 2022-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-9e98dc668394404b907323d9d8d28bc72022-12-22T02:59:20ZengElsevierArthroplasty Today2352-34412022-08-0116242246.e1Total Joint Arthroplasty at a Novel “Hyperspecialty” Ambulatory Surgical Center With Extended Care Suites is as Safe as Inpatient ArthroplastyGraham S. Goh, MD0Taylor D’Amore, MD1P. Maxwell Courtney, MD2William J. Hozack, MD3Chad A. Krueger, MD4Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USARothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USARothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USARothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USACorresponding author. Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut Street, Philaelphia, PA 19107, USA. Tel.: +1 267 339 7813.; Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USABackground: New “hyperspecialty” ambulatory surgical centers (HASCs) have been introduced to deliver safe and cost-efficient care, allowing patients to spend additional nights in an extended care suite before discharge. This study compared the 90-day complications and readmissions of total joint arthroplasty (TJA) at an HASC and inpatient TJA at a tertiary hospital. Methods: We retrospectively reviewed 1365 primary, unilateral, TJAs (658 total hip arthroplasty, 707 total knee arthroplasty) performed at 4 HASCs in 2017-2021. Following their outpatient procedure, patients were discharged to an extended care suite staffed full-time by nurses and physical therapists. These patients were matched 1:1 with 1365 inpatient TJAs (628 total hip arthroplasty, 737 total knee arthroplasty) based on demographics, joint, and American Society of Anesthesiologists (ASA) score. Ninety-day complications and readmissions were compared. Results: The mean age was 60.0 ± 9.8 years and 59.4 ± 8.1 years in the inpatient and outpatient groups, respectively (P = .106). There was no difference in ASA≥3 patients (16.4% vs 17.7%; P = .387) and operative time (86.9 ± 31.8 vs 88.7 ± 27.9 minutes; P = .118). Five patients (0.4%) in the outpatient group were transferred to an acute hospital. When comparing 90-day outcomes between the inpatient and outpatient groups, there was no difference in pulmonary embolism (0.1% vs 0.0%; P = .317), mechanical complications (0.3% vs 0.7%; P = .165), periprosthetic joint infections (0.5% vs 1.1%; P = .092), or readmissions (1.2% vs 1.5%; P = .513). A subgroup analysis of ASA≥3 patients yielded similar findings. Conclusions: Patients undergoing outpatient TJA at a novel HASC had similar complication and readmission rates as those undergoing TJA at a tertiary hospital. Based on these data, such facilities seem appropriate for the care of outpatient TJA patients with ASA<4.http://www.sciencedirect.com/science/article/pii/S2352344122001182OutpatientAmbulatoryKnee arthroplastyHip arthroplastyOutcomesSafety |
| spellingShingle | Graham S. Goh, MD Taylor D’Amore, MD P. Maxwell Courtney, MD William J. Hozack, MD Chad A. Krueger, MD Total Joint Arthroplasty at a Novel “Hyperspecialty” Ambulatory Surgical Center With Extended Care Suites is as Safe as Inpatient Arthroplasty Arthroplasty Today Outpatient Ambulatory Knee arthroplasty Hip arthroplasty Outcomes Safety |
| title | Total Joint Arthroplasty at a Novel “Hyperspecialty” Ambulatory Surgical Center With Extended Care Suites is as Safe as Inpatient Arthroplasty |
| title_full | Total Joint Arthroplasty at a Novel “Hyperspecialty” Ambulatory Surgical Center With Extended Care Suites is as Safe as Inpatient Arthroplasty |
| title_fullStr | Total Joint Arthroplasty at a Novel “Hyperspecialty” Ambulatory Surgical Center With Extended Care Suites is as Safe as Inpatient Arthroplasty |
| title_full_unstemmed | Total Joint Arthroplasty at a Novel “Hyperspecialty” Ambulatory Surgical Center With Extended Care Suites is as Safe as Inpatient Arthroplasty |
| title_short | Total Joint Arthroplasty at a Novel “Hyperspecialty” Ambulatory Surgical Center With Extended Care Suites is as Safe as Inpatient Arthroplasty |
| title_sort | total joint arthroplasty at a novel hyperspecialty ambulatory surgical center with extended care suites is as safe as inpatient arthroplasty |
| topic | Outpatient Ambulatory Knee arthroplasty Hip arthroplasty Outcomes Safety |
| url | http://www.sciencedirect.com/science/article/pii/S2352344122001182 |
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