Advertisement

Same-Day Discharge Total Knee Arthroplasty in Octogenarians

Published:August 17, 2022DOI:https://doi.org/10.1016/j.arth.2022.08.013

      Abstract

      Background

      One of the most important aspects of the transition to outpatient (OP) arthroplasty is patient selection, with guidance traditionally recommending that OP total knee arthroplasty (TKA) be reserved for patients <80 years old. However, there are limited data as to whether older age should really be considered a contraindication to OP-TKA. The purpose of this study is to assess the risk of complications and readmissions following OP-TKA in patients ≥80 years old.

      Methods

      This is a retrospective, propensity-matched cohort study of the National Surgical Quality Improvement Program database from 2011 to 2019. Patients ≥80 years undergoing OP (same-day discharge) TKA were propensity matched to patients ≥80 years undergoing inpatient (IP) TKA based on age, gender, race, body mass index, American Society of Anesthesiologists classification, functional status, smoking status, anesthetic type, and medical comorbidities. There were 1,418 patients (709 IPs and 709 OPs) included. All baseline factors were successfully matched between IP-TKA versus OP-TKA (P ≥ .18 for all). Thirty-day complications, readmissions, reoperations, and mortality were subsequently analyzed.

      Results

      Thirty-day readmission rates were identical between patients undergoing IP-TKA and OP-TKA (3.5% versus 3.5%, P = 1.0). Similarly, there was no significant difference in the incidence of major complications (2.7% versus 2.0%, P = .38), reoperations (1.3% versus 0.8%, P = .44), or mortalities (0.3% versus 0.3%, P = 1.0) within 30 days.

      Conclusion

      Octogenarians undergoing OP-TKA had comparable complication rates to similar patients undergoing IP-TKA. OP-TKA can be performed safely in select octogenarians and age ≥80 years likely does not need to be a uniform contraindication to OP-TKA.

      Keywords:

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Keulen M.H.F.
        • Asselberghs S.
        • Boonen B.
        • Hendrickx R.P.M.
        • van Haaren E.H.
        • Schotanus M.G.M.
        Predictors of (Un)successful same-day discharge in selected patients following outpatient hip and knee arthroplasty.
        J Arthroplasty. 2020; 35: 1986-1992https://doi.org/10.1016/j.arth.2020.03.034
        • Turcotte J.J.
        • Menon N.
        • Aja J.M.
        • Grover J.J.
        • King P.J.
        • MacDonald J.H.
        Preoperative predictors of patients requiring inpatient admission for total hip arthroplasty following removal from the Medicare inpatient-only list.
        J Arthroplasty. 2020; 35: 2109-2113.e1https://doi.org/10.1016/j.arth.2020.03.038
        • Jaibaji M.
        • Volpin A.
        • Haddad F.S.
        • Konan S.
        Is outpatient arthroplasty safe? A systematic review.
        J Arthroplasty. 2020; 35: 1941-1949https://doi.org/10.1016/j.arth.2020.02.022
        • Greenky M.R.
        • Wang W.
        • Ponzio D.Y.
        • Courtney P.M.
        Total hip arthroplasty and the Medicare inpatient-only list: an analysis of complications in medicare-aged patients undergoing outpatient surgery.
        J Arthroplasty. 2019; 34: 1250-1254https://doi.org/10.1016/j.arth.2019.02.031
        • Hoffmann J.D.
        • Kusnezov N.A.
        • Dunn J.C.
        • Zarkadis N.J.
        • Goodman G.P.
        • Berger R.A.
        The shift to same-day outpatient joint arthroplasty: a systematic review.
        J Arthroplasty. 2018; 33: 1265-1274https://doi.org/10.1016/j.arth.2017.11.027
        • Bovonratwet P.
        • Ondeck N.T.
        • Nelson S.J.
        • Cui J.J.
        • Webb M.L.
        • Grauer J.N.
        Comparison of outpatient vs inpatient total knee arthroplasty: an ACS-NSQIP analysis.
        J Arthroplasty. 2017; 32: 1773-1778https://doi.org/10.1016/j.arth.2017.01.043
        • Lovald S.T.
        • Ong K.L.
        • Malkani A.L.
        • Lau E.C.
        • Schmier J.K.
        • Kurtz S.M.
        • et al.
        Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients.
        J Arthroplasty. 2014; 29: 510-515https://doi.org/10.1016/j.arth.2013.07.020
        • Richards M.
        • Alyousif H.
        • Kim J.-K.
        • Poitras S.
        • Penning J.
        • Beaulé P.E.
        An evaluation of the safety and effectiveness of total hip arthroplasty as an outpatient procedure: a matched-cohort analysis.
        J Arthroplasty. 2018; 33: 3206-3210https://doi.org/10.1016/j.arth.2018.05.036
        • Varady N.H.
        • Smith E.L.
        • Clarkson S.J.
        • Niu R.
        • Freccero D.M.
        • Chen A.F.
        Opioid use following inpatient versus outpatient total joint arthroplasty.
        J Bone Joint Surg Am. 2021; 103: 497-505https://doi.org/10.2106/JBJS.20.01401
        • Kort N.P.
        • Bemelmans Y.F.L.
        • van der Kuy P.H.M.
        • Jansen J.
        • Schotanus M.G.M.
        Patient selection criteria for outpatient joint arthroplasty.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2668-2675https://doi.org/10.1007/s00167-016-4140-z
        • Basques B.A.
        • Tetreault M.W.
        • Della Valle C.J.
        Same-day discharge compared with inpatient hospitalization following hip and knee arthroplasty.
        J Bone Joint Surg Am. 2017; 99: 1969-1977https://doi.org/10.2106/JBJS.16.00739
        • Gruskay J.
        • Richardson S.
        • Schairer W.
        • Kahlenberg C.
        • Steinhaus M.
        • Rauck R.
        • et al.
        Incidence and safety profile of outpatient unicompartmental knee arthroplasty.
        Knee. 2019; 26: 708-713https://doi.org/10.1016/j.knee.2019.02.002
        • Pollock M.
        • Somerville L.
        • Firth A.
        • Lanting B.
        Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty: a systematic review of the literature.
        JBJS Rev. 2016; 4: e4https://doi.org/10.2106/JBJS.RVW.16.00002
        • Barnes C.L.
        • Iorio R.
        • Zhang X.
        • Haas D.A.
        An examination of the adoption of outpatient total knee arthroplasty since 2018.
        J Arthroplasty. 2020; 35: S24-S27https://doi.org/10.1016/j.arth.2020.01.073
        • Haas D.A.
        • Zhang X.
        • Davis C.M.
        • Iorio R.
        • Barnes C.L.
        The financial implications of the removal of total knee arthroplasty from the Medicare inpatient-only list.
        J Arthroplasty. 2020; 35: S33-S36https://doi.org/10.1016/j.arth.2020.01.074
        • Bovonratwet P.
        • Fu M.C.
        • Tyagi V.
        • Gu A.
        • Sculco P.K.
        • Grauer J.N.
        Is discharge within a day of total knee arthroplasty safe in the octogenarian population?.
        J Arthroplasty. 2019; 34: 235-241https://doi.org/10.1016/j.arth.2018.10.005
      1. User Guide for the 2018 ACS NSQIP Participant Use Data File. Am Col- Lege Surg Natl Surg Qual Improv Progr. 2019
        • Ondeck N.T.
        • Bohl D.D.
        • Bovonratwet P.
        • Anandasivam N.S.
        • Cui J.J.
        • McLynn R.P.
        • et al.
        Predicting adverse outcomes after total hip arthroplasty: a comparison of demographics, the American society of Anesthesiologists class, the modified charlson comorbidity index, and the modified frailty index.
        J Am Acad Orthop Surg. 2018; 26: 735-743https://doi.org/10.5435/JAAOS-D-17-00009
        • Varady N.H.
        • Ameen B.T.
        • Hayden B.L.
        • Yeung C.M.
        • Schwab P.-E.
        • Chen A.F.
        Short-term morbidity and mortality after hemiarthroplasty and total hip arthroplasty for pathologic proximal femur fractures.
        J Arthroplasty. 2019; 34: 2698-2703https://doi.org/10.1016/j.arth.2019.06.019
        • Varady N.H.
        • Ameen B.T.
        • Schwab P.-E.
        • Yeung C.M.
        • Chen A.F.
        Trends in the surgical treatment of pathological proximal femur fractures in the United States.
        J Surg Oncol. 2019; 120: 994-1007https://doi.org/10.1002/jso.25669
      2. Healthcare cost and utilization project; Agency for Healthcare Research and Quality. Overview of the National (nationwide) Inpatient Sample (NIS). 2016
        • Pugely A.J.
        • Martin C.T.
        • Harwood J.
        • Ong K.L.
        • Bozic K.J.
        • Callaghan J.J.
        Database and registry research in orthopaedic surgery: Part 2: clinical registry data.
        J Bone Joint Surg Am. 2014; 97: 1799-1808https://doi.org/10.2106/JBJS.O.00134
        • Alluri R.K.
        • Leland H.
        • Heckmann N.
        Surgical research using national databases.
        Ann Transl Med. 2016; 4: 393https://doi.org/10.21037/atm.2016.10.49
        • Health I.W.
        IBM MarketScan Research Databases for Health Services Researchers.
        Somers, NY2019
        • Varady N.H.
        • Amen T.B.
        • Chopra A.
        • Freccero D.M.
        • Chen A.F.
        • Smith E.L.
        Out-of-Network facility charges for patients undergoing outpatient total joint arthroplasty.
        J Arthroplasty. 2021; 36: S128-S133https://doi.org/10.1016/j.arth.2021.03.001
        • Amen T.B.
        • Varady N.H.
        • Hayden B.L.
        • Chen A.F.
        Pathologic versus native hip fractures: comparing 30-day mortality and short-term complication profiles.
        J Arthroplasty. 2020; 35: 1194-1199https://doi.org/10.1016/j.arth.2020.01.003
        • Saucedo J.M.
        • Marecek G.S.
        • Wanke T.R.
        • Lee J.
        • Stulberg S.D.
        • Puri L.
        Understanding readmission after primary total hip and knee arthroplasty: who’s at risk?.
        J Arthroplasty. 2014; 29: 256-260https://doi.org/10.1016/J.ARTH.2013.06.003
        • Pugely A.J.
        • Callaghan J.J.
        • Martin C.T.
        • Cram P.
        • Gao Y.
        Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP.
        J Arthroplasty. 2013; 28: 1499-1504https://doi.org/10.1016/J.ARTH.2013.06.032
        • Easterlin M.C.
        • Chang D.G.
        • Talamini M.
        • Chang D.C.
        Older age increases short-term surgical complications after primary knee arthroplasty.
        Clin Orthop Relat Res. 2013; 471: 2611-2620https://doi.org/10.1007/s11999-013-2985-8
        • D’Apuzzo M.R.
        • Pao A.W.
        • Novicoff W.M.
        • Browne J.A.
        Age as an independent risk factor for postoperative morbidity and mortality after total joint arthroplasty in patients 90 years of age or older.
        J Arthroplasty. 2014; 29: 477-480https://doi.org/10.1016/j.arth.2013.07.045
        • Berger P.Z.
        • Gu A.
        • Fassihi S.C.
        • Stake S.
        • Bovonratwet P.
        • Gioia C.
        • et al.
        Increased complications in octogenarians undergoing same-day discharge following total knee arthroplasty: a matched cohort analysis.
        J Knee Surg. 2022; https://doi.org/10.1055/s-0042-1743227
        • Belmont P.J.
        • Goodman G.P.
        • Waterman B.R.
        • Bader J.O.
        • Schoenfeld A.J.
        Thirty-day postoperative complications and mortality following total knee arthroplasty.
        J Bone Joint Surg. 2014; 96: 20-26https://doi.org/10.2106/JBJS.M.00018
        • Ramkumar P.N.
        • Chu C.T.
        • Harris J.D.
        • Athiviraham A.
        • Harrington M.A.
        • White D.L.
        • et al.
        Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis.
        Am J Orthop (Belle Mead NJ). 2015; 44: 397-405
        • Amen T.B.
        • Varady N.H.
        • Wright-Chism J.
        • Bovonratwet P.
        • Parks M.L.
        • Ast M.P.
        Emerging racial disparities in outpatient utilization of total joint arthroplasty.
        J Arthroplasty. 2022; https://doi.org/10.1016/j.arth.2022.05.008
        • Backstein D.
        • Thiagarajah S.
        • Halawi M.J.
        • Mont M.A.
        Outpatient total knee arthroplasty-the new reality and how can it be achieved?.
        J Arthroplasty. 2018; 33: 3595-3598https://doi.org/10.1016/j.arth.2018.09.042
        • Morrell A.T.
        • Layon D.R.
        • Scott M.J.
        • Kates S.L.
        • Golladay G.J.
        • Patel N.K.
        Enhanced recovery after primary total hip and knee arthroplasty: a systematic review.
        J Bone Joint Surg Am. 2021; 103: 1938-1947https://doi.org/10.2106/JBJS.20.02169
        • Medina L.
        • Sabo S.
        • Vespa J.
        • United States Census Bureau
        Living Longer: Historical and Projected Life Expectancy in the United States, 1960 to 2060.
        2020