Safety and Effectiveness of a Stand-Alone Ambulatory Care Joint Replacement Programme

To address the increasing demand of joint replacements as well as addressing the surgical backlog compounded by limited OR resources, a public-private partnership to subcontract bundle care for hip, knee and shoulder replacements was established. The purpose of this study is to assess the safety and effectiveness of a stand-alone ambulatory care joint replacement (ACJR) center. 329 arthroplasty procedures were performed as outpatient: 136 hips, 176 knees, and 17 shoulders since February 2023. 141 (43%) males and 188 (57%) females with a mean age of 66 years (36-88), mean BMI of 29 (18-52), and mean ASA of 2.34 (1 and 4). Outcomes included: failure to discharge on the day of surgery if the patient had a 90-day readmission if the patient had 48 hours, 7 Days, or 30 days ER visit from the time of surgery as well as patient-reported outcome measures (PROMs). PROMs measured included Oxford hip score (OHS), Oxford knee score (OKS), and PROMIS scores.  Following surgery, two patients (<1%) underwent re-operation within 90 days. 9.2% of patients return to ER within 30 days (5.8% within 7 days and 1% within 48 hours). Out of these unexpected healthcare encounters, 2.5% were unrelated, 3.3% required medication adjustments and 6.7% were minor adverse events including minor bleeding, drainage, and pain. None of the ER visits required re-admission. The mean (SD) improvement in OHS was 16.3 (9.9), OKS was 13.1 (10.1) and PROMIS was 5.5 (6.03). A stand-alone ambulatory care joint replacement is a safe and effective method of reducing surgical wait times and improving the delivery of care to patients requiring joint replacement surgery. We hope that this study provides insight for other centres facing similar challenges.