LAS VEGAS — Outpatient and short-stay total hip arthroplasty appears to be safe, but only in a small, healthy subset of Medicare-aged patients, according to a presenter here.
“CMS should allow surgeons and their patients flexibility in determining admission status,” Max Greenky, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting. “Further studies should be used to identify the ideal Medicare patients to undergo outpatient total hip arthroplasty.”
Greenky and his colleagues collected 30-day rates of complications, mortality, readmissions and reoperations for all patients aged 65 years or older undergoing primary THA who were recorded in the American College of Surgeons National Surgical Quality Improvement Program database between 2015 and 2016.
Of the 34,416 patients identified, 1% of patients underwent an outpatient or same day procedure, 15% of patients had a 23-hour short-stay THA and 82% of patients were discharged on postoperative day 2 or later.
“Outpatient and short-stay patients were younger, they were more likely to be Caucasian, they had fewer medical comorbidities and they had [a] higher percentage chance of being male and shorter operative times,” Greenky said.
Greenky noted patients in the inpatient group had higher rates of 30-day complications, which included postoperative wound infection and wound dehiscence, as well as pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection and myocardial infarction. The inpatient group also had higher rates of 30-day readmissions, although patients in the same-day group had a higher rate of reoperation, according to Greenky.
“We also identified that female gender, age over 75 years, minority ethnicity status, getting general anesthesia, having a BMI of 35 or greater, having diabetes, [chronic obstructive pulmonary disease] COPD, [congestive heart failure] CHF, hypertension, malnutrition and an [American Society of Anesthesiologists] ASA score of 4 or greater was associated with a hospital stay of 2 days or longer for developing complications,” Greenky said. – by Casey Tingle
Greenky M, et al. Abstract 138. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 12-16, 2019; Las Vegas.
Disclosure: Greenky reports no relevant financial disclosures.