A Role for Outpatient Total Joint Arthroplasty During the COVID-19 Pandemic.

Abstract

Outpatient total joint arthroplasty (TJA) gained favor during the COVID-19 pandemic. Our objective was to critically evaluate the safety and short-term outcomes of outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) throughout the pandemic compared with pre-pandemic given their increased use. This was a retrospective review of 941 patients who underwent elective, outpatient TKA and THA at a single institution. Patients were divided into two cohorts: pre-pandemic (N=611) and pandemic (N=330). Data points included demographics, comorbidities, failure of same calendar day discharge (SCDD), and 90-day readmissions and re-operations. The pandemic cohort was older (61.0 vs 59.0 years; <i>P</i>=.001) and had a higher Charlson Comorbidity Index (2 vs 1; <i>P</i>=.004). There were no differences between the pandemic and pre-pandemic cohorts regarding SCDD failures (23.3% vs 21.9%; <i>P</i>=.623) and reoperations (4.2% vs 6.2%; <i>P</i>=.205). The pandemic cohort had a lower readmission rate (4.8% vs 8.2%; <i>P</i>=.056). Overall, patients who had failure of SCDD more commonly underwent TKA than THA (63.5% vs 36.5%; <i>P</i><.001), were older (63.0 vs 58.5 years; <i>P</i><.001), had a higher body mass index (30.8 vs 29.9 kg/m²; <i>P</i>=.006) and Charlson Comorbidity Index (2 vs 1; <i>P</i><.001), had an American Society of Anesthesiologists class greater than 2 (51.2% vs 31.6%; <i>P</i><.001), received physical therapy later postoperatively (4.15 vs 3.12 hours; <i>P</i><.001), and had a history significant for myocardial infarction (<i>P</i>=.025), chronic kidney disease (<i>P</i>=.004), or diabetes (<i>P</i>=.003). This study supports broadening indications for outpatient TJA because we found a shift toward older patients with more comorbidities successfully undergoing the procedure. [<i>Orthopedics</i>. 2023;46(5):303-309.].