Same-Day Discharge Periacetabular Osteotomy: A Matched Cohort Analysis.

BACKGROUND

Timely access for young patients who have hip dysplasia can be challenging due to health system resource limitations such as operating room access and hospital beds. This study evaluated the safety and effectiveness of same-day discharge (SDD) periacetabular osteotomy (PAO).

METHODS

There were 59 consecutive patients (mean age 30 years; range, 17 to 50; 60% women) scheduled for SDD. There were 47 outpatients matched with 47 inpatients based on age and a body mass index (BMI). Outpatients had a mean age of 28 years (range, 17 to 46) and BMI of 25.6 (range, 18.9 to 37.1), compared to inpatients between 2015 and 2020 (mean age 28 years, range, 16 to 44; BMI 25.9, range, 19.4 to 34.7). All patients received general anesthesia with multimodal pain management. In the outpatient group, 46.8% had adjunct procedures, compared to 34.0% in the inpatient group. Outcomes included revisits to the emergency department, readmissions, and adverse events (using the modified Sink Dindo Classification).

RESULTS

There were six outpatients (12.8%) who stayed in the hospital for more than 24 hours, with three planned and three having failed to be discharged the same day, averaging a length of stay of 10.1 hours (range, 5.7 to 23.8). The mean length of stay for inpatients was 3.03 days (range, 1.03 to 11.8). None of the unmatched patients had an SDD. Mean outpatient blood loss was 523 mL (range, 200 to 900), and surgery time was 111.9 minutes (range, 70.8 to 169.2), compared to 643 mL (range, 200 to 1,500) and 121.2 minutes (range, 75 to 259.8) for inpatients. There were two outpatients and three inpatients who returned to the emergency department within seven days. At 90 days, both groups had one readmission: a patient who had a wound dehiscence requiring irrigation and debridement and a patient who had an inferior epigastric bleed requiring embolization in outpatient and inpatient groups, respectively.

CONCLUSIONS

Early experience with SDD PAOs shows comparable safety to inpatient PAOs. Optimizing patient education and perioperative management will help facilitate outpatient PAO programs in other centers.