Same Day Total Hip Arthroplasty Performed at an Ambulatory Surgical Center: 90-Day Complication Rate on 549 Patients

Abstract

Background: There is an increasing interest in outpatient total hip arthroplasty (THA), as there are perceived benefits to the patient, insurer, and overall healthcare system. However, the safety of outpatient total joint arthroplasty has not been studied.

Methods: Five hundred forty-nine patients who underwent mini-posterior THA at a freestanding independent ambulatory surgical center (ASC) were reviewed. All patients were discharged to home on the day of surgery.

Results: The average age of the patients was 54.4 years (range 27-73). The average American Society of Anesthesiologists score was 1.6 (range 1-3). Of the 549 patients, 3 (0.5%) admitted from the surgery center to our local hospital. One patient was admitted for pain control after failing to disclose his long-term high-dose narcotic dependence, one patient was admitted for an acetabular component migration identified on postoperative x-ray, and one patient was admitted for hypotension, bradycardia, and an acute polyarthralgia exacerbation. An additional patient was seen 2 days after surgery in a local emergency department for oversedation secondary to narcotics and later discharged to home.

Conclusion: Outpatient THA at an ASC is safe and effective when performed on the appropriately indicated patient. There were 4 visits to the hospital within 2 days of surgery. Only 1 was related to medical events, 2 were pain control and/or medication-related and the final was technique-related. Known orthopedic complications including infection, dislocation, and deep vein thrombosis appear consistent with the literature for a series of this size. Same day discharge THA in an ASC is safe and reproducible.

Keywords: ambulatory surgery; complications; indications; outpatient surgery; rapid recovery; total hip arthroplasty.