As arthroplasty trends toward the outpatient space, the
medical community will be depended upon to carefully follow results to ensure
that patient safety is not compromised. Performing these cases in an ASC will
likely increase in the near future, making some surgeons and patients wary of
losing the safety net of full-service hospitals. Data like the current
manuscript presents will be paramount to overcome these concerns.
The authors report on 243 arthroplasties performed in an
ASC [that were] carefully matched with those in an inpatient setting,
demonstrating no increased risk of complications between groups. One must
recognize that any retrospective case series like this comes with significant
selection bias, even when careful matching occurs. Both surgeons and patients
are motivated to only take the healthiest, most motivated and those with the
most home support to the ASC initially, factors that cannot be fully accounted
for using retrospective matching.
While no statistical differences were found between
groups, the reoperation rate of the ASC group was five-times higher than the
inpatient group (inpatient 0.4% vs. ASC 2.1%, P=.22). This included three reoperations for instability and a
superficial infection following total hip arthroplasty, and an immediate nerve
exploration following hip resurfacing. While these complications are within the
standard of care, future studies with larger numbers and better power should be
performed. Our community must be assured that performing more complex cases in
the ASC setting does not lead to compromise of patient safety.
The authors should be congratulated for sharing timely and
honest data. It is our obligation to continue to do so; our patients’ trust
depends on it.
William G. Hamilton, MD
Orthopedics Today Editorial Board Member
Disclosures: Hamilton reports he is a shareholder in an ASC and routinely performs total joint replacements in the ASC. He also receives royalties and consulting income from DePuy Synthes and Total Joint Orthopedics