Sandoval Luke A, Reiter Charles R, Wyatt Phillip B, Satalich James R, Ernst Brady S, O'Neill Conor N, Satpathy Jibanananda
Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
J Arthroplasty. 2025 Aug;40(8):1992-2000.e2. doi: 10.1016/j.arth.2025.01.036. Epub 2025 Jan 27.
Outpatient total knee arthroplasty (TKA) has quickly grown in popularity, largely driven by policy shifts and the recent coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to compare 30-day complications between outpatient TKA (oTKA) versus inpatient TKA (iTKA) before and after the COVID-19 pandemic to elucidate the effect of the pandemic on utilization and short-term outcomes.
Patients who underwent primary TKA between 2008 and 2021 were identified through Current Procedural Terminology codes in a national database. Propensity score matching controlled for demographic and comorbid differences. The rates of 30-day postoperative complications were compared, and risk factors for adverse events were identified.
A total of 533,503 patients were identified, with 31,905 (6.0%) undergoing oTKA and 501,598 (94.0%) undergoing iTKA. Despite a rise in the frequency of oTKA over time, the rate of any adverse event (AAE) in the oTKA cohort remained significantly lower than that of iTKA (P < 0.001) from 2008 to 2021. This difference was maintained when comparing oTKA to iTKA AAE rates in the pre-COVID (2008 to 2019) and post-COVID (2020 to 2021) periods (P = 0.001 and 0.004, respectively). Postoperative transfusions were less frequent in oTKA cases for all years (P < 0.001) and were less frequent in postpandemic oTKA cases compared to prepandemic oTKA (P = 0.027). When controlling for all other factors, the outpatient operative setting emerged as a risk-reducing factor for AAE in both pre-COVID and post-COVID cohorts. In contrast, age, body mass index, and a history of chronic obstructive pulmonary disease increased the risk of experiencing an adverse event.
Despite a rapid increase in the utilization of oTKA after the onset of the COVID-19 pandemic, 30-day adverse events did not increase and remained lower than that of iTKAs overall. Our findings indicate that oTKA is associated with lower short-term (30-day) complications.
门诊全膝关节置换术（TKA）的普及程度迅速提高，这在很大程度上是由政策转变和近期的2019冠状病毒病（COVID-19）大流行推动的。本研究的目的是比较COVID-19大流行前后门诊TKA（oTKA）与住院TKA（iTKA）的30天并发症，以阐明大流行对手术应用和短期结果的影响。
通过国家数据库中的当前手术操作术语代码确定2008年至2021年间接受初次TKA的患者。倾向评分匹配控制了人口统计学和合并症差异。比较术后30天并发症的发生率，并确定不良事件的危险因素。
共确定533,503例患者，其中31,905例（6.0%）接受oTKA，501,598例（94.0%）接受iTKA。尽管随着时间的推移oTKA的频率有所增加，但从2008年到2021年，oTKA队列中的任何不良事件（AAE）发生率仍显著低于iTKA（P < 0.001）。在比较COVID-19大流行前（2008年至2019年）和大流行后（2020年至2021年）期间oTKA与iTKA的AAE发生率时，这种差异仍然存在（分别为P = 0.001和0.004）。所有年份中，oTKA病例术后输血的频率较低（P < 0.001），与大流行前的oTKA病例相比，大流行后oTKA病例的输血频率更低（P = 0.027）。在控制所有其他因素时，门诊手术环境在COVID-19大流行前和大流行后的队列中均成为AAE的风险降低因素。相比之下，年龄、体重指数和慢性阻塞性肺疾病史会增加发生不良事件的风险。
尽管COVID-19大流行后oTKA的应用迅速增加，但30天不良事件并未增加，总体上仍低于iTKA。我们的研究结果表明，oTKA与较低的短期（30天）并发症相关。
