Is Outpatient Arthroplasty Safe? A Systematic Review.

Background: Advances in perioperative care and growing demand for hospital beds have progressively reduced the length of stay in lower limb arthroplasty. Current trends in population demographics and fiscal climate have also added to this change. Individual institutions have reported good outcomes with outpatient hip and knee arthroplasty. Debate remains regarding the safety of this practice, the optimal protocol, and the applicability in different subsections of population. The primary purpose of this review is to assess the complication and reoperation rates of outpatient arthroplasty.

Methods: We performed a systematic review of all papers reporting on 30 and/or 90-day complication rates of outpatient total hip, total knee, and unicondylar knee arthroplasty published from January 1, 2009 to November 1, 2019. Patient demographics, anesthesia, analgesic protocol, selection criteria, and reasons for failed discharge were also extracted.

Results: Nineteen manuscripts with a total of 6519 operations between them were analyzed as a part of this systematic review. Mean 90-day readmission rates were 2.3% (range 0%-6%) with 1.61% (range 0%-4%) rate. Overall rate of successful same calendar day discharge was 93.4%. Nausea/dizziness was the most common reason identified (n = 45) for failure of discharge.

Conclusion: The patients recruited for outpatient joint arthroplasty were younger, more active, and had suffered from less medical comorbidities than the more typical lower limb arthroplasty patient. There are significant differences in the reported complications between the studies reviewed. More research is needed to establish if an outpatient program can produce similar outcomes to a fast-track program. Further research is also needed to establish the optimal perioperative protocols.