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. 2018 Jan;100-B(1 Supple A):31-35.
doi: 10.1302/0301-620X.100B1.BJJ-2017-0514.R1.

The outpatient total hip arthroplasty : a paradigm change

K R Berend  1 , A V Lombardi Jr  1 , M E Berend  2 , J B Adams  1 , M J Morris  1
Affiliations

The outpatient total hip arthroplasty : a paradigm change

K R Berend et al. Bone Joint J. 2018 Jan.

Abstract

Aims: To examine incidence of complications associated with outpatient total hip arthroplasty (THA), and to see if medical comorbidities are associated with complications or extended length of stay.

Patients and methods: From June 2013 to December 2016, 1279 patients underwent 1472 outpatient THAs at our free-standing ambulatory surgery centre. Records were reviewed to determine frequency of pre-operative medical comorbidities and post-operative need for overnight stay and complications which arose.

Results: In 87 procedures, the patient stayed overnight for 23-hour observation, with 39 for convenience reasons and 48 (3.3%) for medical observation, most frequently urinary retention (13), obstructive sleep apnoea (nine), emesis (four), hypoxia (four), and pain management (six). Five patients (0.3%) experienced major complications within 48 hours, including three transferred to an acute facility; there was one death. Overall complication rate requiring unplanned care was 2.2% (32/1472). One or more major comorbidities were present in 647 patients (44%), including previous coronary artery disease (CAD; 50), valvular disease (nine), arrhythmia (219), thromboembolism history (28), obstructive sleep apnoea (171), chronic obstructive pulmonary disease (COPD; 124), asthma (118), frequent urination or benign prostatic hypertrophy (BPH; 217), or mild chronic renal insufficiency (11).

Conclusion: The presence of these comorbidities was not associated with medical or surgical complications. However, presence of one or more major comorbidity was associated with an increased risk of overnight observation. Specific comorbidities associated with increased risk were CAD, COPD, and frequent urination/BPH. Outpatient THA is safe for a large proportion of patients without the need for a standardised risk assessment score. Risk of complications is not associated with presence of medical comorbidities. Cite this article: Bone Joint J 2018;100-B(1 Supple A):31-5.

Keywords: Ambulatory surgery centre; Complications; Length of stay; Medical co-morbidity; Outpatient; Total hip arthroplasty.

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References

    1. Pollock M, Somerville L, Firth A, Lanting B. Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty: a systematic review of the literature. JBJS Rev 2016;4:01874474–201612000. - PubMed
    1. Bradley B, Middleton S, Davis N, et al. Discharge on the day of surgery following unicompartmental knee arthroplasty within the United Kingdom NHS. Bone Joint J 2017;99-B:788–792. - PubMed
    1. Mason JB. The new demands by patients in the modern era of total joint arthroplasty: a point of view. Clin Orthop Relat Res 2008;466:146–152. - PMC - PubMed
    1. Berend KR, Lombardi AV Jr. Multimodal venous thromboembolic disease prevention for patients undergoing primary or revision total joint arthroplasty: the role of aspirin. Am J Orthop (Belle Mead NJ) 2006;35:24–29. - PubMed
    1. Lee QJ, Chang WY, Wong YC. Blood-sparing efficacy of oral tranexamic acid in primary total hip arthroplasty. J Arthroplasty 2017;32:139–142. - PubMed