Total Hip Surgical Approach Efficiency Outside of Surgical Time in the Ambulatory Surgical Center

Abstract

Background

Rising demand for total hip arthroplasty (THA) in ambulatory surgery centers (ASCs) requires improved efficiency, considering varying surgical approach time requirements, to manage caseloads and ensure safe same-day discharge (SDD). This study examines care phase durations, SDD success and delays, and outcomes, including 90-day complication rates and 1-year patient-reported outcomes (PROs).

Methods

A retrospective review of primary THA patients at a single ASC (January 2019 to January 2021) was conducted. Data on demographics, phase-of-care times, perioperative outcomes, 90-day complications, and PROs were stratified by surgical approach. Comparison was done using 2-tailed t-test and Fisher exact test. Stepwise regression controlled for age, gender, body mass index, assistive device use, class attendance, American Society of Anesthesia score, Charlson comorbidity index, and diagnosis.

Results

Groups differed in age, BMI, assistive device use, class attendance, and preoperative Veterans Rand 12-Item Health Survey physical component scores. The direct anterior approach (DAA) and posterior approach (PA) cohorts showed significant differences in phase-of-care times, except for spinal-time, and total-physical therapy (PT)-time-in-postanesthesia care unit (PACU). DAA was faster in spinal-start-to-incision-time (26.8 versus 35.0; P < 0.001), set-up/take-down-time (20.5 versus 30.2; P < 0.001), operative time (OR; 37.5 versus 50.4; P < 0.001), total operating room time (57.8 versus 80.5; P < 0.001), and arrival-to-discharge-time (383.8 versus 418.4; P < 0.001). PA was faster in time-to-initiation-of-PT (46.3 versus 71.4; P < 0.001), PACU-arrival-to-PT-cleared-time (124.9 versus 144.3; P < 0.001), and total-PACU-time (127.8 versus 143.4; P < 0.001). Surgical approach, age, BMI, and preoperative assistive device use predicted time differences. Excessive spinal was the main cause of PT delays. No differences in 90-day complications or PROs were observed.

Conclusions

DAA showed shorter total OR and arrival-to-discharge-times compared to PA, with similar complications and PROs. Both approaches effectively achieved SDD. Operative and set-up/take-down-time drove DAA efficiency, but PT initiation was delayed due to standard spinal blocks with shorter OR times.