Outpatient Joint Replacement Trends Compared to Hospital Stay
There is a large shift in joint replacement procedures from the hospital setting where patients may spend 1 to 2 days following their procedure to outpatient joint replacement at ambulatory surgical centers where patients are discharged the same day. There have been several recent studies examining the risk of early discharge in terms of readmission rates and complications. The benefits of outpatient joint replacement include less cost on the healthcare system, convenience, and comfort for patients. The factors leading the way for more ambulatory joint replacements are advances in surgical techniques, implant devices, and pain control. Not everyone is an ideal candidate for outpatient joint replacement, however. Patients with certain comorbidities will likely be kept overnight for additional patient monitoring before being discharged home.
One study looked at nearly 1.8 million patients who received an elective total hip or total knee replacement between 2010 and 2017. Those patients were then divided based upon their procedure and whether it was inpatient or outpatient. Remarkably, they found that there was no significant difference in hip replacement patients requiring readmission with 90 days of their procedure between the inpatient and outpatient joint replacement groups. There was a slightly higher risk to the knee replacement patients requiring readmission in the outpatient group, however, complications were not common, occurring in less than 1 percent of patients.
In two other studies, the researchers found that there were no significant differences between hip and knee replacement patients in readmission at 30 and 90 days postoperative. They did, however, find that there was a significant cost reduction with the outpatient joint replacement group compared to the inpatient group. One study calculated an average savings of $3,245 per patient. Another study found an even larger cost reduction going from $19,361 for the inpatient group to $11,677 for the outpatient group, resulting in a 40% decrease. With an estimated 635,000 hip replacements and roughly 1.3 million knee replacements annually by 2030, a savings of 40% would end up saving the healthcare system billions of dollars.
Cost savings is just one of the byproducts of switching to more outpatient joint replacement procedures. The real benefit comes from the advances in surgical practices and technologies that will allow more procedures to be performed outpatient. Advances in remote patient monitoring will also help ensure low complication rates and risk for readmission.
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Steven J. Barad, Stephen M. Howell, Joyce Tom, Arthroplasty Today, Volume 4, Issue 1, 2018, Pages 107-112, ISSN 2352-3441,