Implementation of Outpatient Total Joint Arthroplasty in Canada: Where We are and Where We Need to Go

Same Day Total Hip and Knee Arthroplasty Performed at Canada's First Academic Ambulatory Surgical Center Is Safe and Effective: Population Level Results

BACKGROUND

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are being increasingly performed as an outpatient procedure. Performing these procedures at an ambulatory surgical center (ASC) has been proposed as a way to create greater access to surgical care, improve efficiency, and contain costs. The purpose of this review was to analyze the introduction of a same-day THA and TKA program at Canada's first academic ASC.

METHODS

An inpatient THA and TKA cohort and ASC cohort were developed with aggregate data collected from the Canadian Institute for Health Information and Canadian Joint Replacement Registry spanning January 2019 to March 2021. Quality was assessed via patient length of stay, 30-day readmissions, emergency department visits, and revision surgeries. Costs were assessed utilizing methodology and data provided by Canadian Institute for Health Information. Statistical analysis was performed comparing patient cohorts via Chi-square and t-tests.

RESULTS

Patients in the ASC cohort were significantly younger, more medically complex, and less likely to visit the emergency department within 30 days of surgery (P ≤ 0.001). Overall, 3.7% of patients failed same-day discharge and required a short stay. There was substantial cost savings of 1,721 Canadian Dollars per total joint arthroplasty (TJA) in cases performed at the ASC (P ≤ 0.001).

CONCLUSIONS

A THA and TKA performed at an academic-based ASC reduced costs and additional health care utilization within 30 days of surgery. This model of same-day surgery at an ambulatory center could help improve timely access to care for a proportion of Canadian patients.

Unnecessary interventions for the management of hip osteoarthritis: a population-based cohort study

BACKGROUND

Patients aged 40-60 years who require total hip arthroplasty (THA) often first receive unindicated hip arthroscopy or magnetic resonance imaging (MRI). Our objective was to identify potentially inappropriate resource utilization before THA, specifically reporting on the proportion of patients aged 40-60 years who underwent hip arthroscopy or MRI in the year before THA.

METHODS

We conducted a retrospective, population-based study at the provincial level. We retrieved data from the Canadian Institute for Health Information (CIHI). We included all Ontario residents who underwent an elective, primary THA for osteoarthritis between Apr. 1, 2004, and Mar. 31, 2016. We identified the rates and timing of patients who underwent an MRI or hip arthroscopy before their index THA.

RESULTS

The percentage of patients who underwent an MRI before THA increased significantly over the study period, from 8.7% in 2004 to 23.8% in 2015. There was also a significant but variable trend in the percentage of patients who underwent a hip arthroscopy before THA.

CONCLUSION

Our results demonstrate a high, gradually increasing proportion of patients who received a hip MRI and a low but increasing proportion of patients who received hip arthroscopy in close proximity to THA. Multidisciplinary collaboration may improve knowledge translation and help reduce the rate of clinically unnecessary diagnostic and therapeutic interventions in this population of patients who require THA.

The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis

Purpose

To meet the increasing demands of total shoulder arthroplasty (TSA) while reducing its financial burden, there has been a shift toward outpatient surgery. This systematic review and meta-analysis aimed to evaluate the safety of outpatient TSA.

Methods

The primary objective was to compare re-admission rates and postoperative complications in outpatient versus inpatient TSA. The secondary objectives were functional outcomes and costs. PubMed, Google Scholar, and Web of Science were searched until March 28, 2020. The inclusion criteria were studies reporting at least complications or readmission rates within a period of 30 days or more.

Results

Ten level III retrospective studies were included with 7637 (3.8%) and 192,025 (96.2%) patients underwent outpatient and inpatient TSA, respectively. Outpatient TSA had relatively younger and healthier patients. There were no differences between outpatient and inpatient arthroplasty for 30- and 90-day readmissions. Furthermore, unadjusted comparisons demonstrated significantly less total and major surgical complications, less total, major, and minor medical complications in favour of outpatient TSA. However, subgroup analyses demonstrated that there were no significant differences in all complication if the studies had matched controls and regardless of data source (database or nondatabase studies). The revision rates were similar between both groups at a 12–24 months follow-up. Two studies reported a significant reduction in costs in favour of outpatient TSA.

Conclusion

This study highlights that outpatient TSA could be a safe and effective alternative to inpatient TSA in appropriately selected patients. It was evident that outpatient TSA does not lead to increased readmissions, complications, or revision rates. A potential additional benefit of outpatient TSA was cost reduction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00264-021-04940-7.