Published 7/1/2016
Terry Stanton

Low Complication Rate Reported from New Outpatient TJA Facility

A study tracking patients who underwent total joint arthroplasty (TJA) at a newly opened outpatient facility reported a low number of adverse events during the facility's first year of operation.

The study, presented in a scientific poster at the AAOS Annual Meeting, reported results for 432 patients who underwent either total hip arthroplasty (THA; n = 177) or total knee arthroplasty (TKA; n = 255) in the outpatient surgery center over 13 months. A total of 12 adverse events occurred, with five patients (1.2 percent) requiring hospital readmission. Two of these were due to swelling with pain or hematoma, and three were for dislocation, pneumonia, or infection.

The patients who underwent surgery were discharged less than 24 hours postoperatively. For the study, patient-reported short-term complications were recorded at least 30 days postoperatively.

Patients completed a six-question telephone questionnaire regarding unplanned access of care, hospital readmission, and use of prescription antibiotics. Adverse effects were those involving hospital readmission and complications requiring prescription antibiotics and/or change of the care plan.

Unplanned access of the healthcare system for reasons related to surgery occurred in 47 patients (10.9 percent) and included emergency department visits with a chief complaint or diagnosis related to the surgery and visits to an orthopaedic urgent care facility.

The study, which broke down results for the first 9 months of the facility's operation and those for the following 4.5-month period, found no statistically significant difference in adverse event rates in surgeries performed in the two periods (3.7 percent versus 0.8 percent; P = 0.116). There was, however, a statistically significant difference in rates of unplanned access of care (13.9 percent in the first period and 4.4 percent in the latter; P < 0.01).

Lead author Daniel P. Hoeffel, MD, a surgeon at Summit Orthopaedics in Woodbury, Minn., which opened the ambulatory surgery center in 2014, said that the study represented one of the largest series to date on outpatient total TJA. He said the rates of hospital readmission reported in the study are "lower than those historically reported" for inpatient TJA.

"We view these results as supportive of outpatient TJA from the standpoint of low complication rate and low admission rate," he noted, adding that the findings are "supportive of the inclusion/exclusion criteria developed and implemented in our center."

Dr. Hoeffel's coauthors are Faith Myers, BS, MS; Brandon J. Kelly; Peter J. Daly, MD; and M. R. Giveans, PhD.

The authors' disclosure information can be accessed at www.aaos.org/disclosure

Terry Stanton is the senior science writer for AAOS Now. He can be reached at tstanton@aaos.org.

Bottom Line

  • The study examined results for 432 patients undergoing TJA at a newly opened outpatient surgery facility over approximately 13 months.
  • The overall rate of hospital readmission was 1.2 percent.
  • The rate of unplanned access of the healthcare system was 10.9 percent.
  • A statistically significant lower rate of unplanned access to care was seen in the concluding 4.5-month period of the survey versus that in the first 9 months.