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International Orthopaedics

, Volume 43, Issue 6, pp 1387–1393 | Cite as

Defining growth potential and barriers to same day discharge total knee arthroplasty

  • Megan E. Gillis
  • Johanna Dobransky
  • Geoffrey F. DervinEmail author
Original Paper
  • 131 Downloads

Abstract

Background

Outpatient arthroplasty programs are becoming well established. Adverse event rates have been demonstrated to be no worse than inpatient arthroplasty in the literature for selected patients. The purpose of this study was to determine our rate of outpatient total knee arthroplasty (TKA), examine justification for exclusions, and estimate the proportion of TKAs that can occur safely on an outpatient basis.

Methods

Retrospective case series of 400 consecutive TKAs from Oct 2014 to Mar 2017. Patient demographics, allocation to outpatient surgery vs standard admission, and reason for exclusion from outpatient surgery were recorded. Ninety-day Emergency department (ED) visits, readmission rates, and length of stay (LOS) were compared between groups using independent sample t test and Chi-squared test.

Results

Outpatients were younger (p = 0.001), had lower BMI (p < 0.001), and ASA scores (p < 0.001) than inpatients. One hundred twenty-five (31%) TKAs were assigned to outpatient surgery and 123 achieved discharge on the same day. There was no difference in 90-day ED visits (p = 0.889) or readmission rates (p = 0.338) between groups. Reasons for exclusion from outpatient surgery included medical (absolute 43% and relative 31%), distance > one hour from hospital (18%), no help (7%), and other/unclear (10%). LOS was significantly longer for medical than non-medical exclusions (p < 0.001) and for the absolute compared to relative medical exclusions (p = 0.004).

Conclusion

Outpatient TKA is safe in selected patients, and inclusion can likely be broadened by addressing modifiable exclusions and narrowing medical exclusions. We found that 55% of our TKA population could be appropriate for outpatient surgery.

Keywords

Same day discharge Total knee arthroplasty Outpatient Inpatient Exclusions 

Notes

Compliance with ethical standards

This study was reviewed and approved by the institutional ethics committee and the authors have no conflicts of interest to disclose.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Megan E. Gillis
    • 1
  • Johanna Dobransky
    • 1
  • Geoffrey F. Dervin
    • 1
    • 2
    Email author
  1. 1.Division of Orthopaedic SurgeyThe Ottawa HospitalOttawaCanada
  2. 2.The Ottawa Hospital, General CampusUniversity of Ottawa Division of Orthopedic SurgeryOttawaCanada

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