Goh Graham S, D'Amore Taylor, Courtney P Maxwell, Hozack William J, Krueger Chad A
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Arthroplast Today. 2022 Jul 19;16:242-246.e1. doi: 10.1016/j.artd.2022.05.005. eCollection 2022 Aug.
New "hyperspecialty" ambulatory surgical centers (HASCs) have been introduced to deliver safe and cost-efficient care, allowing patients to spend additional nights in an extended care suite before discharge. This study compared the 90-day complications and readmissions of total joint arthroplasty (TJA) at an HASC and inpatient TJA at a tertiary hospital.
We retrospectively reviewed 1365 primary, unilateral, TJAs (658 total hip arthroplasty, 707 total knee arthroplasty) performed at 4 HASCs in 2017-2021. Following their outpatient procedure, patients were discharged to an extended care suite staffed full-time by nurses and physical therapists. These patients were matched 1:1 with 1365 inpatient TJAs (628 total hip arthroplasty, 737 total knee arthroplasty) based on demographics, joint, and American Society of Anesthesiologists (ASA) score. Ninety-day complications and readmissions were compared.
The mean age was 60.0 ± 9.8 years and 59.4 ± 8.1 years in the inpatient and outpatient groups, respectively ( = .106). There was no difference in ASA≥3 patients (16.4% vs 17.7%; = .387) and operative time (86.9 ± 31.8 vs 88.7 ± 27.9 minutes; = .118). Five patients (0.4%) in the outpatient group were transferred to an acute hospital. When comparing 90-day outcomes between the inpatient and outpatient groups, there was no difference in pulmonary embolism (0.1% vs 0.0%; = .317), mechanical complications (0.3% vs 0.7%; = .165), periprosthetic joint infections (0.5% vs 1.1%; = .092), or readmissions (1.2% vs 1.5%; = .513). A subgroup analysis of ASA≥3 patients yielded similar findings.
Patients undergoing outpatient TJA at a novel HASC had similar complication and readmission rates as those undergoing TJA at a tertiary hospital. Based on these data, such facilities seem appropriate for the care of outpatient TJA patients with ASA<4.
新型“超专科”门诊手术中心（HASC）已投入使用，以提供安全且具成本效益的护理服务，使患者在出院前能在扩展护理套房中多住几晚。本研究比较了HASC行全关节置换术（TJA）与三级医院住院TJA患者的90天并发症及再入院情况。
我们回顾性分析了2017年至2021年在4个HASC进行的1365例初次、单侧TJA手术（658例全髋关节置换术，707例全膝关节置换术）。门诊手术后，患者被转至由护士和物理治疗师全职配备的扩展护理套房。这些患者根据人口统计学、关节及美国麻醉医师协会（ASA）评分与1365例住院TJA患者（628例全髋关节置换术，737例全膝关节置换术）进行1:1匹配。比较90天并发症及再入院情况。
住院组和门诊组的平均年龄分别为60.0±9.8岁和59.4±8.1岁（P = 0.106）。ASA≥3的患者比例（16.4%对17.7%；P = 0.387）及手术时间（86.9±31.8对88.7±27.9分钟；P = 0.118）无差异。门诊组有5例患者（0.4%）被转至急症医院。比较住院组和门诊组的90天结局，肺栓塞（0.1%对0.0%；P = 0.317）、机械并发症（0.3%对0.7%；P = 0.165）、假体周围关节感染（0.5%对1.1%；P = 0.092）或再入院率（1.2%对1.5%；P = 0.513）均无差异。对ASA≥3患者的亚组分析得出类似结果。
在新型HASC接受门诊TJA的患者与在三级医院接受TJA的患者并发症及再入院率相似。基于这些数据，此类设施似乎适合护理ASA<4的门诊TJA患者。
