Study: Varying THA approaches have no impact on same-day discharge surgery
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Key takeaways:
- Researchers found no differences in same-day discharges patients undergoing varying surgical approaches to THA.
- They noted an association between 30-day readmission rates and the posterior approach.
Published results showed no differences in successful same-day discharges from an outpatient hospital for patients who underwent the direct anterior, the anterolateral or the posterior approach to total hip arthroplasty.
Researchers performed a retrospective chart review of 326 same-day THA procedures performed in the ASC setting between July 2019 and October 2021. According to the study, 190 patients (58.3%) underwent the direct anterior approach (DAA); 70 patients (21.5%) underwent the posterior approach (PA); and 66 patients (20.2%) underwent the anterolateral approach (AL). Outcomes included successful same-day discharge, length of surgery, estimated blood loss, complications and readmissions.
Overall, researchers found no association between complications, wound issues, ED visits and revisions and surgical approach. According to the study, 98.5% of patients were successfully discharged on the same day of surgery, with five patients requiring direct admission. The total complication rate was 5.2% (n = 17 patients). Eight patients in the DAA cohort (4.2%), three patients in the AL cohort (4.5%) and six patients in the PA cohort (8.6%) had a complication.
Researchers found an association between 30-day readmission rates and surgical approach as three patients in the PA cohort (4.3%) and no patients in either the DAA or AL cohort were readmitted within 30 days.
“The present study demonstrated that surgical approach in THA performed in a freestanding ambulatory surgery center had no effect on discharge outcomes or complications,” the researchers wrote in the study. “Understanding the results of each approach in THA is becoming more and more valuable for surgeons, patients and institutions as more cases continue to be moved out of the hospitals and into ASCs,” they wrote.
Perspective
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Removal of THA from the inpatient-only list in 2020 has led to an increase in the number of THAs being performed as same-day discharges. As such, it is important to minimize direct admissions and readmissions to the hospital, as well as 30- and 90-day complications. In addition, evaluation of resource utilization is important to ensure fiscal responsibility in the ASC.
In this study by James H. Dove, MD, and colleagues, the authors retrospectively evaluated 326 THAs performed in a free-standing ASC. Overall, 190 had a DA approach, 70 a posterior approach and 66 an anterolateral approach. Complications, including dislocation, wound issues, ED visits and revision surgeries, were no different among the three surgical approaches. Thirty-day readmissions were higher in the posterior approach, but one of only three readmissions were medically related. The DA approach did average a 46-minute longer OR time, questioning the resource utilization for this approach.
There are many factors that may affect complications, readmissions and failure to discharge patients from an ASC. The authors had strict inclusion criteria for those THAs done in the ASC. This study demonstrated that any surgical approach can be performed safely in the ASC and surgeons should feel confident performing the surgical approach they feel most comfortable performing.
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