Same Day Total Hip and Knee Arthroplasty Performed at Canada’s First Academic Ambulatory Surgical Center Is Safe and Effective: Population Level Results

Abstract

Background

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are being increasingly performed as an outpatient procedure. Performing these procedures at an ambulatory surgical center (ASC) has been proposed as a way to create greater access to surgical care, improve efficiency, and contain costs. The purpose of this review was to analyze the introduction of a same-day THA and TKA program at Canada’s first academic ASC.

Methods

An inpatient THA and TKA cohort and ASC cohort were developed with aggregate data collected from the Canadian Institute for Health Information and Canadian Joint Replacement Registry spanning January 2019 to March 2021. Quality was assessed via patient length of stay, 30-day readmissions, emergency department visits, and revision surgeries. Costs were assessed utilizing methodology and data provided by Canadian Institute for Health Information. Statistical analysis was performed comparing patient cohorts via Chi-square and t-tests.

Results

Patients in the ASC cohort were significantly younger, more medically complex, and less likely to visit the emergency department within 30 days of surgery (P ≤ 0.001). Overall, 3.7% of patients failed same-day discharge and required a short stay. There was substantial cost savings of 1,721 Canadian Dollars per total joint arthroplasty (TJA) in cases performed at the ASC (P ≤ 0.001).

Conclusions

A THA and TKA performed at an academic-based ASC reduced costs and additional health care utilization within 30 days of surgery. This model of same-day surgery at an ambulatory center could help improve timely access to care for a proportion of Canadian patients.