Same-Day Discharge vs. Inpatient Joint Replacement

Same-Day Discharge vs. Inpatient Joint Replacement

William P. Barrett, MD

In an article published in the December 6, 2017, Journal of Bone & Joint Surgery, authors Basques, et al, reviewed results of joint replacements performed at a surgery center with those done at an inpatient hospital setting. They looked at a national database for hip and knee replacement from 2005 to 2014. After doing appropriate statistical modeling, they reviewed the outcomes as well as complications and 30-day readmissions. They found no significant differences with regard to complications, though, they did find a greater return to surgery in the outpatient cohort. They also noted patients with elevated body mass index, insulin-dependent diabetes, and elderly patients over 85 had a higher readmission rate following outpatient surgery.

There are a variety of studies that are being published examining the efficacy and safety of same day or outpatient surgery for joint replacement surgery. The majority of papers indicate that in appropriately selected healthy individual’s outpatient surgery is as affective and without increased complications compared to inpatient surgery. Obviously, some patients will not be candidates for outpatient surgery due to medical comorbidities, physical findings and age.

A second article in the same issue of JBJS by Dr. Arshi, et al, found a higher risk of perioperative complications in patients undergoing outpatient knee replacement. This conflicting data underlines the importance of selecting patients appropriately, optimizing them prior to surgery, and then following the results of surgery to determine the safety at any one particular location for potential outpatient surgery placement. We have been following our patients through our hip and knee registry at Proliance Orthopedic Associates in Renton. Over 90% of our patients spend the night and go home the following day after hip and knee replacement surgery. We anticipate breaking ground on an outpatient surgery center for hip and knee replacement as well as spine surgery to be run in conjunction with Valley Medical Center. Stay tuned for details of this exciting development in joint replacement surgery.

Dr. Barrett is an orthopedic surgeon who performs over 500 joint replacement surgeries annually. For more information about total hip and knee replacements, contact Proliance Orthopedic Associates at 425.656.5060.