Receiving Joint Replacement in an Ambulatory Setting Incurs No Increased Risk Compared to In-Patient Procedures

Patients who undergo joint replacement in an ambulatory surgery setting and are discharged the same day do not incur any additional risk than patients who remain in the hospital for several days, according to researchers from the Hospital for Special Surgery (HSS), who included an abstract of their study in a program book at the American Academy of Orthopaedic Surgeons (AAOS) 2019 Annual Meeting.

Over the past decade, the length of stay for patients after completing hip and knee replacement procedures has dropped from approximately four days to under two days. “It’s early in the trend, but there is a massive shift taking place toward more ambulatory hip and knee replacement surgeries that allow that patients go home on the same day of their operations,” said Michael P. Ast, MD, a hip and knee replacement surgeon at HSS, in a press release.

Dr. Ast, along with colleagues, including Alvin C. Ong, MD, at the Rothman Orthopedic Institute, conducted this study after Dr. Ast performed ambulatory surgeries on 126 patients while Dr. Ong completed in-patient surgeries on 126 patients, beginning in 2014. They created a five-year prospective registry of all patients who received ambulatory hip or knee replacement surgeries before comparing the results of the two groups based on surgical procedure, sex, age, body mass index, and health assessments. Among each group, 77 patients underwent total hip replacements while 49 had total knee replacements.

No Increased Risk for Ambulatory Patients

The study’s results suggest a significantly shorter length of stay in the hospital for the ambulatory group (8.09 hours) compared to the inpatient group (23.24 hours). The rate of complications was low in both groups with only 3.9% for the in-patient group juxtaposed to 2.4% for the ambulatory group. Moreover, the results indicate no discernable difference between groups for readmission rates. Furthermore, the average costs per patient were notably lower for the ambulatory group ($11,677) compared to the in-patient group ($19,361). These included all costs incurred in performing the surgery, such as staffing, medications, implanting, and immediate postoperative care.

“I was very pleased to see there were no increased risks in complications or readmissions for ambulatory patients,” said Dr. Ast. “But I didn’t expect the cost difference would be so large—40% less for the ambulatory group compared to the in-patient group.”

Researchers noted that by the year 2030, there will be an estimated 635,000 hip replacements and 1.28 million knee replacements every year; they also noted that if “up to half of those are ambulatory procedures, at a savings of 40%, the healthcare system will save billions,” adding, “but patient outcomes are still our number one priority.”