Key result
Outpatient total knee arthroplasty is linked to ~134% more serious adverse events vs inpatient procedures.
Why the study?
Total knee arthroplasty is increasingly performed as an outpatient procedure, but its safety compared with the inpatient setting is not well established.
Does outpatient total knee arthroplasty increase the risk of serious adverse events compared to inpatient procedures in patients undergoing primary elective unilateral total knee arthroplasty?
Cohort (n=2,198)
Yes
Does outpatient total knee arthroplasty increase the risk of serious adverse events compared to inpatient procedures in patients undergoing primary elective unilateral total knee arthroplasty?
Outpatient total knee arthroplasty is associated with a higher risk of serious adverse events compared to inpatient procedures, which should be considered during surgical planning and consent.
Answers are grounded in this paper and cite their sources.
May support caution with outpatient total knee arthroplasty; leaves open causality and generalizability due to observational design.
BACKGROUND: Many factors are driving total knee arthroplasty to be performed more commonly as an outpatient (<24 hour discharge) procedure. Nonetheless, the safety of total knee replacements performed in the outpatient setting is not well established when compared with inpatient setting. The purpose of this study is to compare the postoperative outcomes of outpatient and inpatient total knee arthroplasties. METHODS: The 2015 and 2016 American College of Surgeons National Surgical Quality Improvement Program data sets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty. The primary outcome was serious adverse events defined by a composite outcome including: return to operating room, wound-related infection, thromboembolic event, renal failure, myocardial infarction, cardiac arrest requiring cardiopulmonary resuscitation, cerebrovascular accident, use of ventilator >48 hours, unplanned intubation, sepsis/septic shock, and death. Propensity matched analysis was used to adjust for potential confounding covariates. RESULTS: 1099 patients undergoing outpatient total knee arthroplasty (1% of total cases) were successfully matched to 1099 patients undergoing inpatient surgeries. The composite rate of serious adverse events was greater in outpatient procedures compared with inpatient procedures (3.18% vs 1.36%, p=0.005). In contrast, failure to rescue and readmission rates were not different between groups. CONCLUSIONS: Outpatient total knee arthroplasty is associated with a higher composite risk of serious adverse events than inpatient procedures. Anesthesiologists and surgeons should inform patients and discuss this information when obtaining consent for surgery and planning for discharge timing.
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Mukhdomi et al. (2020) conducted a cohort in Primary, elective, unilateral total knee arthroplasty (n=2,198). Outpatient total knee arthroplasty vs. Inpatient total knee arthroplasty was evaluated on Serious adverse events (composite of return to operating room, wound-related infection, thromboembolic event, renal failure, myocardial infarction, cardiac arrest, cerebrovascular accident, etc.) (p=0.005). Outpatient total knee arthroplasty was associated with a higher composite rate of serious adverse events compared with inpatient procedures (3.18% vs 1.36%, p=0.005).
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