Fast-track inpatient and outpatient TKAs may yield similar outcomes, complications
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Key takeaways:
- Inpatient vs. outpatient fast-track total knee arthroplasties yielded similar outcomes.
- Inpatient vs. outpatient procedures had similar rates of intraoperative complications and 90-day complications.
According to published results, patients who underwent inpatient vs. outpatient fast-track total knee arthroplasty procedures had similar rates of complications, readmissions and reoperations at 90 days.
Researchers performed a prospective matched cohort study of 174 patients who underwent outpatient fast-track TKA and 316 patients who underwent inpatient fast-track TKA between October 2019 and December 2020.
Researchers found an intraoperative complication rate of 2% for both patients who underwent outpatient fast-track TKA (n = 3) and patients who underwent inpatient fast-track TKA (n = 6).
Researchers also found similar complication rates at 90 days postoperatively between the groups. Patients who underwent outpatient surgery had similar rates of total complications with no readmission (8% vs. 7.9%, respectively), complications with readmission but no reoperation (1.1% vs. 0.6%, respectively) and complications with reoperation (4% vs. 4.4%, respectively) compared with patients who underwent inpatient surgery.
Researchers noted no differences in postoperative Oxford Knee Scores between the groups.
“These findings may encourage hesitant surgeons to move toward outpatient TKA pathways, as there is no greater risk of early postoperative complications that could be more difficult to manage after discharge,” the researchers wrote in the study.
Perspective
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In this study by Jean-Yves Jenny, MD, and colleagues, further evidence is provided to demonstrate no significant differences in postoperative complication rates between outpatient and inpatient fast-track total knee arthroplasties. This important work adds to the growing body of literature supporting the safety and efficacy of outpatient fast-track TKA when it is introduced into already optimized fast-track setups. This study further highlights the potential to optimize health care resources without compromising patient outcomes for those patients eligible for same-day discharge.
The findings of this study are corroborated by a larger multicenter study conducted in Denmark that implemented outpatient hip and knee arthroplasty across seven public hospitals. The Danish study achieved a notable increase in same-day discharge rates, increasing from 6% in the control period to 21% during the study period. The alignment of these results with those of Jenny and colleagues strengthens the evidence base for outpatient fast-track TKA, confirming its feasibility on a broader scale.
When considering the generalizability of the study by Jenny and colleagues, it should be noted that the Danish study also highlighted variability in discharge rates between centers, influenced by local practices and prior experience with outpatient surgery. This variability underscores the need for standardized protocols and training to ensure consistent outcomes across different settings.
Overall, the research by Jenny and colleagues, supported by the Danish multicenter study, strongly advocates for the adoption of outpatient fast-track TKA, emphasizing its potential for safe, efficient and effective patient care. However, when implementing such fast-tack pathways, teams should continue to be mindful to “walk before we run” and remember that the fast-track concept is based on the reduction of undesirable pathophysiological responses to surgery to enhance recovery. This means prioritizing “first better, then faster” in the adoption and introduction of new pathways and protocols.
References:
Danielsen O, et al. Acta Orthop. 2024;doi:10.2340/17453674.2024.40185.
Wainwright TW, et al. Br J Anaesth. 2021;doi:10.1016/j.bja.2020.09.038.
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