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Comparative Study
. 2020 Aug 31;15(1):367.
doi: 10.1186/s13018-020-01871-8.

Outpatient vs. inpatient hip arthroplasty: a matched case-control study on a 90-day complication rate and 2-year patient-reported outcomes

Philip J Rosinsky  1 , Sarah L Chen  2 , Mitchell J Yelton  1 , Ajay C Lall  1   3   4 , David R Maldonado  1 , Jacob Shapira  1 , Mitchell B Meghpara  1   4 , Benjamin G Domb  5   6   7
Affiliations
Comparative Study

Outpatient vs. inpatient hip arthroplasty: a matched case-control study on a 90-day complication rate and 2-year patient-reported outcomes

Philip J Rosinsky et al. J Orthop Surg Res. .

Abstract

Background: The transition to outpatient-based surgery is a major development occurring in recent years in the field of total hip arthroplasty (THA). The effect of this transition on patient-reported outcomes (PROs) is still not well established. The purpose of the current study was to compare patients undergoing inpatient THA (iTHA) to patients undergoing outpatient THA (oTHA) regarding (1) perioperative variables including surgical time, blood loss, and length of stay (2) 90-day complication rates and unplanned emergency room or office visits (3) 2-year PROs including modified Harris hip score (mHHS), Harris hip score (HHS), forgotten joint score (FJS), pain, and satisfaction, as well as the quality of live measures.

Methods: The American Hip Institute registry was analyzed for patients undergoing THA between July 2014 and April 2016. The first 100 patients undergoing oTHA were selected and matched to 100 patients undergoing iTHA via propensity matching based on the following variables: age, sex, body mass index (BMI), Charlson comorbidity index (CCI), and smoking status. The primary outcomes were PROs at 2 years post-operatively. The secondary outcomes were perioperative surgical variables, 90-day complication rates, and unplanned emergency and clinic visits.

Results: After exclusions, 91 patients remained in each group and were compared. The oTHA group showed improved 2-year PROs with regard to mHHS (91.5 vs. 86.2; P = 0.02), HHS (92.3 vs. 87.4; P = 0.02), and pain (1.0 vs. 1.5; P = 0.04). The oTHA group had an average length of stay of 6.8 h compared to 43.2 h for the iTHA group (P < 0.001). There were no significant differences between the groups regarding readmissions, emergency room visits, and unplanned clinic visits. Complications and revision rates were similar in both groups.

Conclusion: In appropriately selected, younger patients, oTHA can achieve improved postoperative 2-year PROs compared to iTHA. We found no differences regarding postoperative short-term complications or 2-year revision rates, and no differences in unplanned office visits or readmissions.

Level of evidence: Prognostic level 3.

Keywords: Outpatient arthroplasty; Patient-reported outcomes; Total hip arthroplasty.

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Conflict of interest statement

Dr. Rosinsky reports food/beverage and travel/lodging support from Arthrex, Stryker, and Smith & Nephew.

Ms. Chen has no disclosures.

Mr. Yelton has no disclosures.

Dr. Lall reports educational support from the Medwest and Smith & Nephew; research support from Arthrex, Stryker, and Medacta; food and beverage from Smith & Nephew, Stryker, Zimmer Biomet, Arthrex; travel and lodging from Stryker and Arthrex; and consulting fees from Arthrex and Graymont Medical. Dr. Lall is the Medical Director of Hip Preservation at St. Alexius Medical Center.

Dr. Maldonado reports food/beverage and travel/lodging support from Arthrex, Stryker, and Smith & Nephew. Dr Maldonado is also a board member of the Journal of Arthroscopy.

Dr. Shapira reports food/beverage and travel/lodging support from Arthrex, Stryker, and Smith & Nephew.

Dr. Meghpara reports educational support, food/beverage, and travel/lodging from Arthrex, Stryker, and Smith & Nephew.

Dr. Domb has HAD ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; has received research support from Arthrex, ATI, the Kauffman Foundation, Stryker, and Pacira Pharmaceuticals; has received consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; has received educational support from Arthrex, Breg, and Medwest; has received speaking fees from Arthrex and Pacira Pharmaceuticals; and receives royalties from Arthrex, DJO Global, MAKO Surgical, Stryker, and Orthomerica. Dr. Domb is the Medical Director of Hip Preservation at St. Alexius Medical Center, a board member for the American Hip Institute Research Foundation, AANA Learning Center Committee, the Journal of Hip Preservation Surgery, and the Journal of Arthroscopy. The American Hip Institute Research Foundation fund research and is where our study was performed.

Figures

Fig. 1
Fig. 1
Patient selection flow diagram. THA: total hip arthroplasty
Fig. 2
Fig. 2
a Mean ± SD, mHHS: modified Harris Hip Score, HHS: Harris Hip Score, FJS: Forgotten Joint Score. b Mean ± SD, VAS: visual analog scale
See this image and copyright information in PMC

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References

    1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet Lond Engl. 2007;370:1508–1519. doi: 10.1016/S0140-6736(07)60457-7. - DOI - PubMed
    1. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018;100:1455–1460. doi: 10.2106/JBJS.17.01617. - DOI - PubMed
    1. DeCook CA. Outpatient joint arthroplasty: transitioning to the ambulatory surgery center. J Arthroplast. 2019;S0883540319300336. - PubMed
    1. Argenson J-NA, Husted H, Lombardi A, Booth RE, Thienpont E. Global forum: an international perspective on outpatient surgical procedures for adult hip and knee reconstruction. J Bone Jt Surg. 2016;98:e55. doi: 10.2106/JBJS.15.00998. - DOI - PubMed
    1. Berger RA, Jacobs JJ, Meneghini RM, Della Valle C, Paprosky W, Rosenberg AG. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop. 2004;429:239–247. doi: 10.1097/01.blo.0000150127.80647.80. - DOI - PubMed

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