Home E-Weekly March 18, 2014

Where Should Total Joints Be Performed?

Published: March 17, 2014

Joint replacement outcomes are similar regardless of whether patients are discharged the day of surgery or spend a night in the hospital, according to research presented last week at the annual conference of the American Academy of Orthopaedic Surgeons.

The study involved the review of 137 patients who underwent outpatient total joint replacements and 106 who underwent the surgeries as inpatients between September 2010 and May 2011. According to the findings, 10.2% of patients discharged the day of surgery were readmitted within 30 days of their procedures, as compared to 6.6% of inpatients. Researchers did not see the outpatient population's higher overall readmission rate as a statistically significant difference.

Importantly, patients who qualified for outpatient surgery had BMIs of less than 40 and no history of cardiopulmonary issues, sleep apnea, deep vein thrombosis or blood clots. They lived less than an hour from where the surgery was performed and had "good" family support at home. Patients who underwent inpatient procedures presented with similar considerations, but stayed overnight based on surgeon judgment.

Advances in anesthesia and pain management have permitted the migration of complex orthopedic procedures to outpatient facilities, but Medicare's levying of financial penalties for unplanned hospital admissions within 30 days of surgery have put patient recoveries under increased scrutiny, says David N. Vegari, MD, of Main Line Orthopaedics & Sports Medicine in Wynnewood, Pa., the study's lead author.

Outpatient total joint procedures have the potential to slash healthcare costs and improve patient satisfaction, he says, but he concedes further studies are needed to drill down to the root causes of unplanned readmissions to help lower rates and "improve the safety and efficacy of outpatient surgery."

Daniel Cook

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