Comparable Outcomes of Total Joint Arthroplasty Performed at Ambulatory Surgery Centers and Hospital Outpatient Departments.

Abstract

As the volume of outpatient total joint arthroplasty (TJA) continues to rise, evaluating outcomes across surgical settings has become increasingly important. Our study compared rates of 90-day complications between patients undergoing outpatient TJA at an ambulatory surgery center (ASC) and a hospital outpatient department (HOPD). Patients undergoing primary TJA at a single institution between June 2016 and April 2024 with a minimum of 90-day follow-up were retrospectively identified (ASC: n = 615, 49.6%; HOPD: n = 624; 50.4%). Demographics and 90-day outcomes, including complications, readmissions, and reoperations, were documented. Univariate and multivariate logistic regressions, including Firth's correction for scarce events, were performed for all evaluated outcomes while adjusting for sex, body mass index (BMI), Charlson Comorbidity Index (CCI), and procedure type. The incidence of medical (1.1 versus 1.9%; odds ratio (OR) 0.55; P = 0.230) and surgical complications (3.3% versus 2.9%; OR 1.01; P = 0.977) were comparable between the ASC and HOPD cohorts, respectively. Specifically, the risk of periprosthetic joint infection (PJI) (ASC: 0.8% versus HOPD: 0.5%; OR 1.25; P = 0.770), wound complications (1.8% versus 2.0%, OR 0.72; P = 0.458), and 90-day readmission (2.8% versus 4.0%; OR 0.66; P = 0.356) were not significantly different. Similarly, there were no differences in the incidence of 90-day revision (1.0% versus 1.0%; OR 0.77; P = 0.674) or reoperation (1.6% versus 2.6%; OR 0.55; P = 0.163) between surgical settings. Although there was a trend towards ASC patients having a lower risk of any complication at 90 days (4.6% versus 6.7%; OR 0.61; P = 0.061), this finding was not statistically significant with the number of patients studied. The present analysis found comparable 90-day outcomes between patients undergoing outpatient TJA at an ASC and HOPD. These findings reaffirm the safety of outpatient TJA regardless of outpatient setting. Additionally, these findings suggest that other factors such as facility costs and patient preference may be considered when determining a surgical setting given comparable low rates of complications.