Revision TKA in ASC associated with decreased costs, readmissions vs. inpatient setting
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Key takeaways:
- Revision knee arthroplasty in the ASC was associated with decreased costs and readmissions.
- The ASC setting may be preferred vs. the inpatient or hospital-based outpatient setting for simple revision procedures.
With decreased 30-day postoperative costs and 90-day readmission rates, revision total knee arthroplasty performed in the ASC may be preferred vs. an inpatient or a hospital-based outpatient setting, according to published results.
Researchers performed an observational cohort study of 6,515 patients (mean age, 60.8 years) who underwent revision TKA in an inpatient setting (n = 5,407; 83%), hospital-based outpatient setting (n =979; 15%) or ASC (n = 129; 2%) from 2018 to 2020. Outcomes included 30-day postoperative surgical costs, 90-day readmission rates and postoperative ED visits.
Researchers found patients who underwent surgery in the inpatient setting had the highest 30-day postoperative costs vs. patients who underwent surgery in the ASC or hospital-based outpatient setting. They noted one-component revision was more common in the ASC (62%) and hospital-based outpatient setting (50.7%) compared with an inpatient setting (39.6%).
Readmission rates were 10.8% (n = 582) for the inpatient setting, 10.2% (n = 100) for the hospital-based outpatient setting and 1.6% (n = 2) for the ASC setting at 90 days postoperatively. In addition, the rate of ED visits was 16.5% (n = 890) for the inpatient setting, 14.3% (n = 140) for the hospital-based outpatient setting and 7.8% (n = 10) for the ASC setting at 90 days postoperatively.
“The ASC may be a suitable setting for simpler revisions performed for less severe indications and is associated with lower costs, 90-day readmissions and ED visit rates,” the researchers wrote in the study.
Perspective
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As a pioneer in minimally invasive, outpatient total hip and total knee replacement, I have been performing outpatient arthroplasties for more than 23 years, helping more than 15,000 patients get a new joint and return home the same day. Despite initial skepticism within the orthopedic community, we have demonstrated that outpatient surgeries for primary joint replacement are safer, more effective and provide more advantages to patients than inpatient surgeries. While surgeries in ASCs were initially reserved for younger and healthier patients, now more than 90% of my primary joint replacement surgeries are done on an outpatient basis.
Moreover, I have been involved in research and published articles demonstrating that primary total joint replacement in ASCs results in improved patient satisfaction, lower infection rates, reduced costs and more convenience for patients. This current study from Boston reaffirms the same advantages for patients undergoing revision surgeries. We have also found that it is safe and effective to perform revision arthroplasties in ASCs, and I am now performing up to five revision surgeries a week in outpatient settings.
In general, patients who have surgeries in ASCs receive dedicated and specialized care and individualized attention by medical personnel. Because of this, the risk of complications is greatly reduced as compared to a hospital setting. In addition, because patients are in a controlled environment and away from other sick patients, the infection rate is significantly lower.
I am delighted that more studies reveal that ASCs provide an excellent, effective and safe surgical venue for all joint replacement patients — whether they are having arthroplasties or revisions.
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