Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Arthroplasty. 2024 Aug;39(8):2074-2081. doi: 10.1016/j.arth.2024.02.048. Epub 2024 Feb 22.
With the removal of total hip arthroplasty (THA) from the inpatient-only (IPO) lists, the orthopedic landscape across the United States has changed rapidly. Thus, this study aimed to: 1) characterize the change in THA volume for outpatient and inpatient surgeries; 2) elucidate demographical differences before and after removal from the IPO list; and 3) analyze 30-day complications, readmissions, and reoperations.
The National Surgical Quality Improvement Program database was queried for primary THAs between January 2010 and December 2021. The primary outcome was the annual volume of outpatient and inpatient THAs. Secondary outcomes involved 30-day complications, readmissions, and reoperations. The variables between cohorts were analyzed using goodness-of-fit Chi-square tests with summary statistics.
Of the 332,423 THAs between 2010 and 2021, 88% were inpatient THAs (n = 292,974) and 12% were outpatient THAs (n = 39,449). From 2019 to 2021, the volume of inpatient THA decreased by 55% (42,779 to 19,075), while outpatient THA increased by 751% (2,518 to 21,424). Patients who had a THA after 2019 were older (P < .001), more commonly women (P < .001), white (P < .001), and more likely American Society of Anesthesiologists Class III (P < .001). The outpatient cohort had fewer 30-day complications, readmissions, and reoperations. The length of stay for both cohorts decreased until 2019, before increasing in 2020 and 2021 for inpatient THAs, while home discharge and operative time increased for both.
The volume of outpatient THA increased almost eightfold after its removal from the IPO lists in 2020. Despite expanding eligibility with older patients and more comorbidities, 30-day complications, readmissions, and reoperations remain low. These findings support the safe transition to outpatient THA with appropriate patient selection and optimization.
随着全髋关节置换术（THA）从仅限住院（IPO）清单中移除，美国各地的骨科格局迅速发生变化。因此，本研究旨在：1）描述门诊和住院手术的 THA 量变化；2）阐明从 IPO 清单中移除前后的人口统计学差异；3）分析 30 天并发症、再入院和再次手术。
从 2010 年 1 月至 2021 年 12 月，国家手术质量改进计划数据库中查询了原发性 THA。主要结果是每年门诊和住院 THA 的数量。次要结果包括 30 天并发症、再入院和再次手术。使用具有汇总统计信息的拟合优度卡方检验分析队列之间的变量。
在 2010 年至 2021 年间的 332423 例 THA 中，88%为住院 THA（n=292974），12%为门诊 THA（n=39449）。从 2019 年到 2021 年，住院 THA 的数量减少了 55%（42779 到 19075），而门诊 THA 增加了 751%（2518 到 21424）。2019 年后接受 THA 的患者年龄更大（P<0.001），更常见为女性（P<0.001）、白人（P<0.001）和美国麻醉医师协会（ASA）III 级（P<0.001）更多。门诊组的 30 天并发症、再入院和再次手术较少。两个队列的住院时间都减少了，直到 2019 年，然后在 2020 年和 2021 年住院 THA 的住院时间增加，而家庭出院和手术时间都增加了。
在 2020 年从 IPO 清单中移除后，门诊 THA 的数量增加了近 8 倍。尽管随着老年患者和更多合并症的增加，扩大了资格，但 30 天并发症、再入院和再次手术仍然较低。这些发现支持通过适当的患者选择和优化，安全过渡到门诊 THA。
