Ponugoti Nikhil, Magill Henry
The James Cook University Hospital, Middlesbrough, England, UK.
Chelsea and Westminster Hospital, London, UK.
BMC Musculoskelet Disord. 2025 Apr 8;26(1):349. doi: 10.1186/s12891-025-08510-5.
The rise in the adoption of outpatient arthroplasty has been attributed to its cost-effectiveness, although safety concerns persist. In this meta-analysis, we compare inpatient and outpatient joint arthroplasty with a primary focus on readmission and complication rates, using exclusively high-quality prospective data. Cost-effectiveness was used as a secondary outcome measure.
A literature search was performed in Medline, Embase and Cochrane Library from inception to October 2023. A predefined strategy was used to conduct a systematic review and meta-analysis. Twelve studies were deemed eligible for inclusion. These were critically appraised using RoB analysis and MINORS criteria. Overall readmission rate, readmission rate for THA, readmission rate for TKA, complication rate and cost-analysis were selected as outcomes of interest. Forest plots were extracted using RevMan 5.3.5 software.
The twelve studies included 2470 patients, of which 1052 were outpatients and 1418 inpatient subjects undergoing arthroplasty. Forest plot analysis showed no significant difference in safety outcomes (readmission and complication rates). However, there were significantly lower costs in the outpatient group compared to the inpatient group. The results of the analysis were; overall readmission rate (Odds ratio 0.66; P= 0.29; I=18%), readmission rate in THA (odds ratio 0.62; P=0.10; I=51%), readmission rate in TKA (odds ratio 0.67; P=0.56; I=0%), overall complication rate (odds ratio 0.77; P=0.12; I=38%) and cost analysis (RR -2.88; P<0.00001; I= 93%).
This meta-analysis demonstrates that outpatient total joint arthroplasty (TJA) is a safe option, when compared to inpatient surgery. However, it is clear that further prospective studies and long-term randomized clinical data are necessary for a more comprehensive understanding.
门诊关节置换术的采用率上升归因于其成本效益，尽管安全问题依然存在。在这项荟萃分析中，我们比较住院和门诊关节置换术，主要关注再入院率和并发症发生率，仅使用高质量的前瞻性数据。成本效益作为次要结果指标。
在Medline、Embase和Cochrane图书馆进行了从创刊到2023年10月的文献检索。使用预定义策略进行系统评价和荟萃分析。12项研究被认为符合纳入标准。使用RoB分析和MINORS标准对这些研究进行严格评估。选择总体再入院率、全髋关节置换术（THA）再入院率、全膝关节置换术（TKA）再入院率、并发症发生率和成本分析作为感兴趣的结果。使用RevMan 5.3.5软件提取森林图。
12项研究纳入2470例患者，其中1052例为门诊患者，1418例为接受关节置换术的住院患者。森林图分析显示安全结果（再入院率和并发症发生率）无显著差异。然而，门诊组的成本显著低于住院组。分析结果为：总体再入院率（比值比0.66；P = 0.29；I = 18%）、THA再入院率（比值比0.62；P = 0.10；I = 51%）、TKA再入院率（比值比0.67；P = 0.56；I = 0%）、总体并发症发生率（比值比0.77；P = 0.12；I = 38%）和成本分析（风险比 -2.88；P < 0.00001；I = 93%）。
这项荟萃分析表明，与住院手术相比，门诊全关节置换术（TJA）是一种安全的选择。然而，显然需要进一步的前瞻性研究和长期随机临床数据以获得更全面的理解。
