In the JournalsPerspective

Similar complication risks seen with outpatient vs inpatient arthroplasty procedures

Craig J. Della Valle

According to a recently published study, arthroplasty surgeries among appropriately selected patients may be performed safely at an ambulatory surgery center, without an increased risk for complications.

"These results suggest that in appropriately selected patients outpatient surgery in a free standing [ambulatory surgery center] ASC can be performed as safely as an inpatient hospital stay," Craig J. Della Valle, MD, told Healio.com/Orthopedics.

Della Valle and colleagues identified 243 consecutive patients who underwent outpatient arthroplasty and compared them to 243 patients who underwent inpatient arthroplasty. Investigators used the American Society of Anesthesiologists score and BMI. Reoperation, readmission, unplanned clinic or emergency department visits and major and minor complications were among the 90-day complications compared with the 2-sample proportions test.

Results showed the readmission rates for inpatient and outpatient patients were 2.1%. Investigators noted there was no statistically significant differences seen in the rates of major and minor complications, reoperations, emergency department visits and unplanned clinic visits among the cohorts. – by Monica Jaramillo

 

Disclosures: Della Valle reports he is a consultant for DePuy Synthes, Smith & Nephew and Zimmer-Biomet; receives research support from Smith & Nephew and Stryker; and receives royalties from Zimmer-Biomet.

 

Craig J. Della Valle

According to a recently published study, arthroplasty surgeries among appropriately selected patients may be performed safely at an ambulatory surgery center, without an increased risk for complications.

"These results suggest that in appropriately selected patients outpatient surgery in a free standing [ambulatory surgery center] ASC can be performed as safely as an inpatient hospital stay," Craig J. Della Valle, MD, told Healio.com/Orthopedics.

Della Valle and colleagues identified 243 consecutive patients who underwent outpatient arthroplasty and compared them to 243 patients who underwent inpatient arthroplasty. Investigators used the American Society of Anesthesiologists score and BMI. Reoperation, readmission, unplanned clinic or emergency department visits and major and minor complications were among the 90-day complications compared with the 2-sample proportions test.

Results showed the readmission rates for inpatient and outpatient patients were 2.1%. Investigators noted there was no statistically significant differences seen in the rates of major and minor complications, reoperations, emergency department visits and unplanned clinic visits among the cohorts. – by Monica Jaramillo

 

Disclosures: Della Valle reports he is a consultant for DePuy Synthes, Smith & Nephew and Zimmer-Biomet; receives research support from Smith & Nephew and Stryker; and receives royalties from Zimmer-Biomet.

 

    Perspective
    William G. Hamilton

    William G. Hamilton

    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