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In the first study to establish patient satisfaction after outpatient joint arthroplasty in an academic medical center setting, patients indicated they were very likely to undergo an outpatient procedure again and had high patient reported outcomes (PROs).

The study, “Patient Satisfaction and Outcomes following Outpatient Joint Arthroplasty in Academic Medical Centers,” also showed that patients had short discharge times and low readmission rates after outpatient joint arthroplasty.

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These findings were presented at the 2023 annual meeting of the American Academy of Orthopaedic Surgeons

Impact of Length of Stay

Total joint arthroplasty (TJA) and unicompartmental knee arthroplasty (UKA) are increasingly being performed on an outpatient basis, with some predictions showing that more than half of all joint replacement procedures will be outpatient by 2026. Although previous studies have reported on patient satisfaction in ambulatory surgery centers (ASCs), no studies had evaluated patient satisfaction and outcomes for outpatient joint replacement at academic medical centers.

“Academic medical centers historically haven’t done TJAs on a same day basis,” said lead author Soham Ghoshal, a medical student at Harvard Medical School. “The literature has shown that one of the biggest factors influencing patient satisfaction and whether they would undergo these procedures at [academic medical centers] is the length of stay.

“This is important because a longer length of stay is often associated with a higher risk of medical errors, complications, and lower recovery metrics. Inpatient procedures are more expensive as well.

“If we can show that patients want these procedures on an outpatient basis, that it is safe, and [that] outcomes are similar, we can help guide AMCs to shift TJAs and UKAs to outpatient.”

Data on 281 Procedures Evaluated

The researchers conducted a prospective cohort study among patients who underwent TJA or UKA at 2 large academic medical centers between May 1, 2018, and December 31, 2021. They evaluated data on a total of 101 TJAs (66 total hip and 35 total knee arthroplasties) and 180 UKAs performed on an outpatient basis at these centers.

Patients were surveyed on whether they would repeat the surgery, their experience with same-day discharge, and reasons for readmission or reoperation. Patient-reported outcomes were assessed with the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) survey and the Knee Disability and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR) survey. The PROs of interest included pain, stiffness, and difficulty when performing hip or knee movements.

Study Findings

The study authors reported that:

• Cumulatively, 94.6% of patients would undergo their procedure again, with 100% of THA, 93.8% of TKA and 93.3% of UKA patients saying they would redo the surgery.
• Of all patients, 92.7% would choose to be discharged the same day again, with 94.3% of THA, 81.3% of TKA and 95.6% of UKA patients stating that if they needed the surgery again, they would have their surgery on an outpatient basis.
• The mean time to discharge was 5.4 hours for THA, 4.9 hours for TKA and 4.7 hours for UKA.
• The THA patients reported a mean HOOS JR score of 95.6. The KOOS JR scores were 89.8 for TKA patients and 86.3 for UKA patients 3.
• A total of 9 patients were readmitted, with readmission rates of 3.0% for THA, 2.9% for TKA, and 5.6% for UKA. There were no repeated readmissions.

“Overwhelmingly, joint arthroplasty patients would have the procedure done as outpatient if they had to again,” said Vivek M. Shah, MD, FAAOS, director of outpatient arthroplasty at Brigham and Women’s Hospital in Boston and a faculty member at Harvard Medical School.

“Our study showed that there are many benefits for the patient and healthcare system to patients being discharged that same day as the procedure at an [academic medical center. These institutions] have the advantage that should a patient need to be admitted for further observation, that transition can easily be done.”