Key result
Outpatient primary TJA at an ASC requires direct hospital admission in only ~0.45% of patients.
Why the study?
Although failure to launch after primary total joint arthroplasty has been investigated in hospitals, data in the ambulatory surgical center setting are lacking.
What is the incidence and cause of failure to launch in patients undergoing primary total joint arthroplasty at an ambulatory surgical center?
Observational (n=1,974)
No
What is the incidence and cause of failure to launch in patients undergoing primary total joint arthroplasty at an ambulatory surgical center?
Same-day discharge following primary total joint arthroplasty at an ambulatory surgical center is highly successful (99.6%), with failure to launch being rare and mostly due to unpreventable syncopal events.
Supports high SDD success rates in screened ASC TJA patients; leaves open prospective validation of syncope prevention strategies.
BACKGROUND: There has been a tremendous increase in same-day discharge (SDD) following primary total joint arthroplasty (TJA). Although the concept of failure to launch (FTL) has been recently investigated in hospital settings, there is a paucity of data in the ambulatory surgical center (ASC) context. This study aimed to examine the incidence and underlying causes of FTL within an ASC at a major academic medical center. METHODS: A retrospective review from 2021 to 2024 was performed on all patients who underwent same-day surgery at our ASC after intentional selection and medical optimization per institutional protocols. The demographic information, incidence and source of FTL, 90-day readmissions, and reoperations/revisions were recorded. There were 1,974 patients who underwent primary TJA at the ASC during the study. RESULTS: There were nine patients who required direct hospital admission from the ASC (0.45%). This patient population had significantly increased American Society of Anesthesiologists score compared to patients who were discharged home. In addition, these patients had a significantly higher number of 90-day emergency department visits. Syncopal episodes were the most common reason for hospital admission from the ASC (66.7%), followed by nausea, seizures, and pain (all 11.1%). After review by attending orthopaedic surgeons and anesthesiologists, only two patients had potentially preventable medical causes for admission. CONCLUSIONS: Approximately, 99.6% of patients had successful SDD at our ASC, underscoring the importance of proper preoperative screening. Only 0.45% of patients required hospital admission, primarily attributed to hypotension and syncopal events. Interestingly, only two patients in our cohort experienced a potentially preventable instance of FTL. It is crucial that additional efforts be aimed at identifying patients at risk and implementing treatment strategies to prevent postoperative hypotension and syncopal events that may further improve SDD and outcomes in outpatient TJA in the ASC setting.
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Chandrashekar et al. (2024) conducted an observational in Primary total joint arthroplasty (n=1,974). Outpatient primary total joint arthroplasty was evaluated on Direct hospital admission from the ambulatory surgical center (failure to launch). Outpatient primary total joint arthroplasty at an ambulatory surgical center was highly successful, with only 0.45% of patients experiencing failure to launch requiring hospital admission.
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