Outpatient total hip arthroplasty can be safe and effective when performed at an ambulatory surgery center (ASC) when the procedure is performed on appropriately screened patients, according to a presentation at the annual meeting of the American Academy of Orthopaedic Surgeons.
The authors say that while outpatient total hip arthroplasty (THA) is thought to be beneficial for patients, payers, and the overall healthcare system, the safety of outpatient total joint procedures has not been qualified.
To determine the safety, the researchers examined the records of 549 patients who underwent surgery at a freestanding, independent ASC between 2008 and 2014. Factors that played a role in the decision to have an ambulatory procedure included the patient’s age, comorbidities, and how motivated the patient was to have a rapid recovery. The mini-posterior approach was used for the procedure, and the patients received a short-acting spinal with lidocaine.
The patients had an average age of 54.4 years, but they ranged from 27 to 73 years old. The average American Society of Anesthesiologists Physical Classification Score was 1.6, but it ranged from 1 to 3. Three patients (0.5%) were admitted from the surgery center to a hospital. One admission was for pain control after the patient failed to disclose that he had long-term high-dose narcotic dependence, the authors said. Another patient was admitted for an acetabular component migration that was identified on a postoperative X-ray. The third patient was admitted for hypotension, bradycardia, and an acute polyarthralgia exacerbation. A fourth patient was seen at an emergency department two days after surgery for oversedation secondary to narcotics. That patient was discharged home.
Ten (1.8%) patients were hospitalized postoperatively at an average of 15.7 days who needed irrigation and drainage for hematoma or delayed wound healing. Five (0.9%) postoperative infections were identified on average at postoperative day 35 that were treated with surgery. Six (1%) patients had dislocated hips between days 0 and 77. One of the patients had a postoperative X-ray that identified the dislocated hip. That patient had an immediate revision and was discharged that day. Three (0.5 %) patients had venous thromboembolism.
“Same day discharge THA in an ambulatory surgical center is safe and reproducible,” the authors conclude. (Readers can view the abstract online at bit.ly/1T7zjX0. For more information about outpatient hip arthroplasty, see our SDS Manager column, “Can you offer total hips and knees in 23 hours? Yes!” Same-Day Surgery, May 2015, at bit.ly/1Ub6bQ7.)