Abstract
Background
Current patient selection criteria and medical risk stratification methods for outpatient
primary total joint arthroplasty (TJA) surgery are unproven. This study assessed the
predictive ability of a medically based risk assessment score in selecting patients
for outpatient and short stay surgery.
Methods
A retrospective review of 1120 consecutive primary TJAs in an early discharge program
was performed. An Outpatient Arthroplasty Risk Assessment (“OARA”) score was developed
by a high-volume arthroplasty surgeon and perioperative internal medicine specialist
to stratify patients as “low-moderate risk (≤59)” and “not appropriate” (≥60) for
early discharge. OARA, American Society of Anesthesiologists Physical Status Classification
System (ASA-PS), and Charlson comorbidity index (CCI) scores were analyzed with respect
to length of stay.
Results
The positive predictive value of the OARA score was 81.6% for the same or the next
day discharge, compared with that of 56.4% for ASA-PS (P < .001) and 70.3% for CCI (P = .002) scores. Patients with OARA scores ≤59 were 2.0 (95% confidence interval [CI],
1.4-2.8) times more likely to be discharged early than those with scores ≥60 (P < .001), while a low ASA-PS score was 1.7 (95% CI, 1.2-2.3) times more likely to
be discharged early (P = .001). CCI did not predict early discharge (P ≥ .301). With deliberate patient education and expectations for outpatient discharge,
the odds of early discharge predicted by the OARA score, but not the ASA-PS score,
increased to 2.7 (95% CI, 1.7-4.2).
Conclusion
The OARA score for primary TJA has more precise predictive ability than the ASA-PS
and CCI scores for the same or next day discharge and is enhanced with a robust patient
education program to establish appropriate expectations for early discharge. Early
results suggest that the OARA score can successfully facilitate appropriate patient
selection for outpatient TJA, although consideration of clinical program maturity
before adoption of the score is advised.
Keywords
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Article info
Publication history
Published online: March 13, 2017
Accepted:
March 3,
2017
Received in revised form:
February 26,
2017
Received:
December 30,
2016
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.03.004.
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