Here are eight studies on outpatient joint replacement covered by Becker's ASC Review so far in 2019:
1. A new study published inThe Journal of Arthroplasty examined outpatient total joint replacements and one-night inpatient joint replacements to compare the burden of care for surgeons.The study authors analyzed 103 consecutive total joint replacement patients who underwent the procedures in April 2014. All patients were discharged either within five hours of surgery or the next morning. The total burden of care for joint replacement patients was 2.5 touches per patient and 160 outgoing phone calls to patients with 93 incoming calls coming from the total joint patients. When the researchers included time spent by the specialized education team, the patients required 83.1 hours of clinical time, with the average time per patient being 48.4 minutes.
2. A new study suggests there isn't an increased risk for patients undergoing outpatient joint replacements performed in the ASC setting when compared with the inpatient hospital setting, according to new research from New York City-based Hospital for Special Surgery and Philadelphia-based Rothman Orthopaedic Institute. There was not a meaningful difference in complications or readmission rates between the two groups, and the surgery cost for the ASC group was 40 percent less than the hospital group. On average, outpatient surgery cost $11,677, with inpatient surgery costing $19,361.
3. Outpatient total ankle arthroplasty may be a better option than inpatient surgery for certain patients, according to research published in The Journal of Foot and Ankle Surgery. Researchers used the National Surgical Quality Improvement Program database to examine data from 66 outpatients and 535 inpatients who had undergone total ankle arthroplasty. Postoperative complication rates for surgical site infections, hematologic complications and operating room readmissions were compared between the two patient groups. Seventy-one percent of outpatients and 93 percent of inpatients said they were satisfied with their choice to undergo surgery in their respective settings.
4. Outpatient, short-stay total hip arthroplasty is safe for select Medicare-aged patients, according to research published in the Journal of Arthroplasty. Researchers studied data on patients who underwent primary total hip arthroplasty between 2015 and 2016, comparing 30-day complications, readmission and reoperation rates for inpatient, outpatient and short-stay groups. Patents who underwent outpatient surgery or were short-stay patients had lower 30-day readmission and complication rates than the inpatient groups.
5. Patient-level costs for primary elective inpatient total shoulder arthroplasty were higher than those for outpatient procedures, according to research published in the Journal of Shoulder and Elbow Surgery. Researchers used the Texas Health Care Information Collection database to analyze outpatient and inpatient total shoulder arthroplasties performed between 2010 and 2015 for patient-level costs determined by whether a surgery center was inpatient or outpatient, as well as a center's volume. The study found inpatient costs were significantly higher than outpatient costs for total shoulder arthroplasty, at $76,109 and $22,907, respectively.
6. A bundled payment program can lower 90-day episode of care costs for Medicare patients undergoing total hip and knee arthroplasty, according to research published in the Journal of Arthroplasty. Researchers studied 319 patients — 38 underwent total hip arthroplasty while 287 underwent bilateral total knee arthroplasty. There were 239 patients in the bundled payment group. The bundled payment group had reduced hospital costs ($21,251 vs. $18,783), post-acute care costs ($13,488 vs. $12,439) and overall 90-day episode of care costs ($39,733 vs. $34,305).
7. Anticholinergics and cholinesterase inhibitors during anesthesia may need to be avoided in patients undergoing outpatient total joint arthroplasty in an ASC due to the risk of postoperative urinary retention, according to research published in the Journal of Arthroplasty. Researchers examined data from 685 consecutive, unilateral total joint arthroplasty patients who were discharged the same day or the day after their surgery. Postoperative urinary retention was diagnosed by a perioperative internal medicine specialist. The researchers analyzed a sample of 633 procedures. Postoperative urinary retention incidence was 5.5 percent, and 3.9 percent for same day discharges, and outpatient surgery was not associated with an increased risk of postoperative urinary retention.
8. Research presented at the American Academy of Orthopaedic Surgeons' 2019 Annual Meeting March 12-16 in Las Vegas found Medicare-insured patients that follow an enhanced recovery after surgery protocol may be discharged early after outpatient total knee or hip arthroplasty. The study included retrospective chart review data of 645 consecutive Medicare patients who underwent primary total knee arthroplasty (337 patients) or total hip arthroplasty (308 patients) between June 1, 2015 and November 16, 2017. Beyond the initial seven-day prescription given at discharge, 84.2 percent of patients did not need any additional opioid prescriptions.