College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
J Bone Joint Surg Am. 2021 Apr 7;103(7):593-600. doi: 10.2106/JBJS.20.01307.
Outpatient joint arthroplasty is a potential modality for increased case throughput and is rising in demand. However, we are aware of no study that has compared outcomes between risk-matched outpatient and inpatient procedures within the last 7 years. The aims of this study were to compare matched patient cohorts who underwent outpatient or inpatient joint arthroplasty in terms of 30-day adverse events and readmission rates.
From the National Surgical Quality Improvement Program database, we identified patients who underwent primary total hip arthroplasty (THA), primary total knee arthroplasty (TKA), and primary unicompartmental knee arthroplasty (UKA) from 2009 to 2018. Using 10 perioperative variables, patients who underwent an outpatient procedure were 1:4 propensity score-matched with patients who underwent an inpatient procedure. The rates of 30-day adverse events and readmission were compared using the McNemar test. The risk factors for adverse events and readmissions were identified using multivariate regression.
Of 574,375 patients identified, 21,506 (3.74%) underwent an outpatient procedure. After propensity score matching, an outpatient joint arthroplasty was associated with a lower rate of adverse events (3.18% compared with 7.45%; p < 0.001). When assessed individually, outpatient TKA (3.15% compared with 8.11%; p < 0.001), THA (4.94% compared with 10.05%; p < 0.001), and UKA (1.78% compared with 3.39%; p < 0.001) were all associated with fewer adverse events overall and there was no difference in the rate of 30-day readmission, when compared with inpatient analogs. Outpatient joint arthroplasty was an independent factor for lower adverse events (odds ratio [OR], 0.407 [95% confidence interval (CI), 0.369 to 0.449]; p < 0.001), with no increase in the risk of readmission (OR, 1.004 [95% CI, 0.878 to 1.148]; p = 0.951).
Contemporary outpatient joint arthroplasty demonstrated lower rates of adverse events with no increased rate of 30-day readmission when compared with risk-matched inpatient counterparts. Although multiple factors should guide the decision for the site of care, outpatient arthroplasty may be a safe alternative to inpatient arthroplasty.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
门诊关节置换术是增加病例吞吐量的一种潜在方式，需求不断上升。然而，我们没有发现任何一项在过去 7 年内比较风险匹配的门诊和住院手术之间结果的研究。本研究的目的是比较在 30 天内不良事件和再入院率方面接受门诊或住院关节置换术的匹配患者队列。
我们从国家手术质量改进计划数据库中确定了 2009 年至 2018 年间接受初次全髋关节置换术（THA）、初次全膝关节置换术（TKA）和初次单髁膝关节置换术（UKA）的患者。使用 10 个围手术期变量，将接受门诊手术的患者与接受住院手术的患者进行 1:4 的倾向评分匹配。使用 McNemar 检验比较 30 天内不良事件和再入院率。使用多变量回归确定不良事件和再入院的风险因素。
在确定的 574375 名患者中，21506 名（3.74%）接受了门诊手术。在进行倾向评分匹配后，门诊关节置换术与较低的不良事件发生率相关（3.18%比 7.45%；p<0.001）。单独评估时，门诊 TKA（3.15%比 8.11%；p<0.001）、THA（4.94%比 10.05%；p<0.001）和 UKA（1.78%比 3.39%；p<0.001）总体上均与不良事件发生率降低相关，与住院类似物相比，30 天内再入院率无差异。门诊关节置换术是不良事件发生率降低的独立因素（比值比[OR]，0.407[95%置信区间（CI），0.369 至 0.449]；p<0.001），再入院风险无增加（OR，1.004[95%CI，0.878 至 1.148]；p=0.951）。
与风险匹配的住院对照组相比，当代门诊关节置换术显示出较低的不良事件发生率，且 30 天内再入院率无增加。尽管多种因素应指导护理场所的决策，但门诊关节置换术可能是住院关节置换术的安全替代方案。
治疗性 III 级。有关证据水平的完整说明，请参阅作者说明。
