From the Department of Orthopaedic Surgery, Harvard Medical School, Boston Shoulder Institute, Massachusetts General Hospital, Boston, MA (Simon, Warner, and O'Donnell), Avant-garde Health, Boston, MA (Liu, Zhang, Beck da Silva Etges, Jones, and Haas), Department of Orthopaedic Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD (Srikumaran and Best), Department of Orthopaedics and Rehabilitation, Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA (Armstrong), Department of Orthopedics, Northwest Permanente PC, Portland, OR (Khan), Cooper Bone and Joint Institute, Cooper University Hospital, Camden, NJ (Fedorka), Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Gottschalk), Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA (Kirsch), California Shoulder Institute, Menlo Park, CA (Costouros), and the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA (Abboud and Fares).
J Am Acad Orthop Surg. 2024 Aug 1;32(15):e741-e749. doi: 10.5435/JAAOS-D-23-00572. Epub 2024 Mar 6.
Total joint arthroplasties (TJAs) have recently been shifting toward outpatient arthroplasty. This study aims to explore recent trends in outpatient total joint arthroplasty (TJA) procedures and examine whether patients with a higher comorbidity burden are undergoing outpatient arthroplasty.
Medicare fee-for-service claims were screened for patients who underwent total hip, knee, or shoulder arthroplasty procedures between January 2019 and December 2022. The procedure was considered to be outpatient if the patient was discharged on the same date of the procedure. The Hierarchical Condition Category Score (HCC) and the Charlson Comorbidity Index (CCI) scores were used to assess patient comorbidity burden. Patient adverse outcomes included all-cause hospital readmission, mortality, and postoperative complications. Logistic regression analyses were used to evaluate if higher HCC/CCI scores were associated with adverse patient outcomes.
A total of 69,520, 116,411, and 41,922 respective total knee, hip, and shoulder arthroplasties were identified, respectively. Despite earlier removal from the inpatient-only list, outpatient knee and hip surgical volume did not markedly increase until the pandemic started. By 2022Q4, 16%, 23%, and 36% of hip, knee, and shoulder arthroplasties were discharged on the same day of surgery, respectively. Both HCC and CCI risk scores in outpatients increased over time ( P < 0.001).
TJA procedures are shifting toward outpatient surgery over time, largely driven by the COVID-19 pandemic. TJA outpatients' HCC and CCI risk scores increased over this same period, and additional research to determine the effects of this should be pursued.
Level III, therapeutic retrospective cohort study.
全关节置换术（TJA）最近已转向门诊关节置换术。本研究旨在探讨门诊 TJA 手术的近期趋势，并研究是否患有更高合并症负担的患者正在接受门诊关节置换术。
筛选了 2019 年 1 月至 2022 年 12 月期间接受全髋关节、膝关节或肩关节置换术的 Medicare 按服务收费报销患者的记录。如果患者在手术当天出院，则认为该手术为门诊手术。使用分层条件类别评分（HCC）和 Charlson 合并症指数（CCI）评分评估患者的合并症负担。患者不良结局包括全因住院再入院、死亡和术后并发症。使用逻辑回归分析评估更高的 HCC/CCI 评分是否与不良患者结局相关。
分别确定了 69520、116411 和 41922 例膝关节、髋关节和肩关节全关节置换术。尽管膝关节和髋关节手术的门诊手术量在更早地从仅限住院名单中删除，但直到大流行开始时才明显增加。到 2022 年第四季度，分别有 16%、23%和 36%的髋关节、膝关节和肩关节置换术在手术当天出院。门诊患者的 HCC 和 CCI 风险评分均随时间推移而增加（P<0.001）。
随着时间的推移，TJA 手术逐渐转向门诊手术，这主要是由 COVID-19 大流行推动的。在此期间，TJA 门诊患者的 HCC 和 CCI 风险评分也有所增加，应进一步研究确定这对患者的影响。
III 级，治疗性回顾性队列研究。
