Outpatient Surgery Safe for Total Hip Save

ORLANDO -- Total hip replacement can be performed safely and effectively on an outpatient basis for healthy patients, a researcher reported here.

From 2008 to 2014, a total of 549 patients underwent mini-posterior arthroplasty at a single ambulatory surgical center and were discharged the same day, according to Gregg R. Klein, MD, an orthopedic surgeon in Paramus, N.J.

Only three of the 549 patients (0.5%) were admitted to the local hospital following discharge from the outpatient facility -- one for pain control after having failed to acknowledge a longstanding dependence on high-dose narcotics, one for migration of the acetabular component, and one for polyarthralgia with hypotension, he explained at the annual meeting of the American Academy of Orthopaedic Surgeons.

"There were no medical or surgical events relating to having the surgery done as an outpatient that placed patients at risk," he said.

Total hip arthroplasties have excellent clinical results, and have been increasingly performed using rapid recovery protocols. In recent years, there has been growing interest in the possibility of ambulatory surgery and the associated potential benefits for patient, insurance company, and overall healthcare system alike.

However, safety of this approach has not been fully assessed, so Klein and colleagues organized a registry of patients treated at their facility. Patient age and comorbidities were considerations in the choice of outpatient surgery, with the average American Society of Anesthesiologists overall health score being 1.6. Of particular importance was the patient's motivation for a rapid recovery, he noted.

Patients' mean age was 54, and 68% were men. Mean body mass index was 28 kg/m2.

The average time until the patient was up and walking was 2.5 hours, and the time to discharge was 7.37 hours.

In addition to the three patients who were admitted to the hospital the day of the surgery, one other patient was seen 2 days later because of excessive sedation, and 10 others were hospitalized for irrigation and drainage following hematomas or delayed wound healing during the first postoperative month.

Hematomas developed in 5% of the first 100 patients, but in only 1.1% of the subsequent patients. "We feel that the increased rate of hematomas among the first 100 patients was related to aggressive anticoagulation combined with rapid patient mobilization, and by adjusting the prophylaxis protocol the rate of this complication was decreased significantly," he said.

Other complications included 0.9% of patients with infections -- occurring on average 35 days post-surgery -- - dislocations in 1%, and venous thrombolembolism in 0.5%. One of these was popliteal and two were in a superficial vein below the knee.

"Same-day discharge in an ambulatory surgical center is safe and reproducible," he concluded.

The authors reported financial ties with the ambulatory surgical center.

This article is brought to RheumNow by our friends at MedPage Today. It was originally published on March 3, 2016.