Outpatient and Inpatient Fast-Track Knee Arthroplasty Show Similar Complication Rates, unravels study

Total knee arthroplasty is a common procedure aimed at relieving pain and restoring function in patients with severe knee arthritis. Traditional inpatient TKA involves several days of hospital stay, but recent advances have led to the development of fast-track protocols, which can significantly shorten recovery time. This study aimed to compare the complication rates and clinical outcomes of propensity-matched patients undergoing FT TKA in outpatient versus inpatient settings.

In this prospective study, 629 patients who underwent FT TKA were followed for 90 days post-surgery. The participants were divided into outpatient (n = 176) and inpatient (n = 462) groups based on consultations between surgeons and patients. Propensity scores based on age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores were used to match outpatient to inpatient FT TKA in a 1:2 ratio. Complications were categorized into intraoperative complications, complications without readmission, complications with readmission but no reoperation, and complications with reoperation. The cumulative incidence function (CIF) was computed to analyze the time to postoperative complication diagnosis within the first 90 days.

• After propensity score matching, 173 outpatients and 316 inpatient FT TKAs were compared.

• The study found no significant differences in intraoperative complication rates (2% in both groups).

• At the 90-day follow-up, total complications without readmission were 8.0% in outpatients and 7.9% in inpatients.

• Complications with readmission but no reoperation were 1.1% for outpatients and 0.6% for inpatients.

• Complications requiring reoperation occurred in 4.0% of outpatients and 4.4% of inpatients.

• The CIF analysis revealed no significant differences in the timing of postoperative complication diagnosis between the outpatient and inpatient groups.

The findings indicate that outpatient FT TKA is as safe as inpatient FT TKA in terms of 90-day postoperative complication rates, intraoperative complications, readmissions, and reoperations. This supports the growing trend towards outpatient surgical pathways, which can offer benefits such as reduced healthcare costs and improved patient convenience without compromising safety.

This study demonstrates that outpatient FT TKA has similar complication rates and clinical outcomes to inpatient FT TKA, suggesting that outpatient pathways are a safe and effective option for suitable patients. These findings may encourage more surgeons to adopt outpatient FT TKA, potentially leading to broader application and benefits for patients and healthcare systems alike.

Reference:

Jenny, J.-Y., Godet, J., Muller, J. H., Kumble, A., Ramos-Pascual, S., Saffarini, M., Biette, G., Boisrenoult, P., Brochard, D., Brosset, T., Cariven, P., Chouteau, J., Hulet, C., Demey, G., Villeminot, J., & de Ladoucette, A. (2024). Complication rates are not higher after outpatient versus inpatient fast-track total knee arthroplasty: A propensity-matched prospective comparative study. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2024.06.006