Assessment of 90-Day Outcomes Following Total Joint Arthroplasty in Ambulatory Surgery Centers, Hospital Outpatient Departments, and Hospitals: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis
Simarjeet Puri MD , Martin Weaver MD , Lisheng Chen PhD , Tae Kim MHSA , Elizabeth Dailey MD , David C. Markel MD
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引用次数: 0
Abstract
Background
Total joint arthroplasty is shifting from hospitals to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). A Michigan Arthroplasty Registry Quality Collaborative Initiative quality improvement project examined readmissions, emergency room (ER) visits, periprosthetic joint infection (PJI), fracture, and dislocation after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) across sites.
Methods
Primary TJAs between July 1, 2021, and June 30, 2022 (N = 41,696: 3910 ASC, 1,834 HOPD, and 35,952 hospital) were reviewed. Of 17,100 THAs, 9.5% (1,631) were at ASCs, 4.7% (798) at HOPDs, and 85.8% (14,671) at hospitals. Of 24,596 TKAs, 9.3% (2,279) were at ASC, 4.2% (1,036) at HOPDs, and 86.5% (21,281) at hospitals. Hospitals treated more elderly, women, non-White, obese, diabetics, smokers, and governmental insurance.
Results
For THAs, ASCs had the lowest 30-day (ASC 1%, HOPD 1.8%, hospital 3.4%, P < .001) and 90-day (ASC 1.7%, HOPD 3.4%, hospital 5.5%, P < .001) readmissions, 30-day ER visits (ASC 1.8%, HOPD 3.5%, hospital 5.3%, P < .001), and fractures (ASC 0.4%, HOPD 0.6%, hospital 1.2%, P < .001). Similar trends were observed for TKAs: 30-day readmissions (ASC 1.3%, HOPD 1.4%, hospital 3.1%, P < .001), 90-day readmissions (ASC 2.2%, HOPD 2.3%, hospital 5.2%, P < .001), and 30-day ER visits (ASC 3%, HOPD 6.5%, hospital 6.4%, P < .001). PJI (THA: P = .1, TKA: P = .6) and dislocation rates (P = .5) were similar across sites.
Conclusions
Patients receiving primary total joint arthroplasty at an ASC had the least postoperative hospital-based care despite similar rates of PJI and dislocation.
期刊介绍:
Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.