A Role for Outpatient Total Joint Arthroplasty During the COVID-19 Pandemic

Abstract

Outpatient total joint arthroplasty (TJA) gained favor during the COVID-19 pandemic. Our objective was to critically evaluate the safety and short-term outcomes of outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) throughout the pandemic compared with pre-pandemic given their increased use. This was a retrospective review of 941 patients who underwent elective, outpatient TKA and THA at a single institution. Patients were divided into two cohorts: pre-pandemic (N=611) and pandemic (N=330). Data points included demographics, comorbidities, failure of same calendar day discharge (SCDD), and 90-day readmissions and re-operations. The pandemic cohort was older (61.0 vs 59.0 years; P =.001) and had a higher Charlson Comorbidity Index (2 vs 1; P =.004). There were no differences between the pandemic and pre-pandemic cohorts regarding SCDD failures (23.3% vs 21.9%; P =.623) and reoperations (4.2% vs 6.2%; P =.205). The pandemic cohort had a lower readmission rate (4.8% vs 8.2%; P =.056). Overall, patients who had failure of SCDD more commonly underwent TKA than THA (63.5% vs 36.5%; P <.001), were older (63.0 vs 58.5 years; P <.001), had a higher body mass index (30.8 vs 29.9 kg/m 2 ; P =.006) and Charlson Comorbidity Index (2 vs 1; P <.001), had an American Society of Anesthesiologists class greater than 2 (51.2% vs 31.6%; P <.001), received physical therapy later postoperatively (4.15 vs 3.12 hours; P <.001), and had a history significant for myocardial infarction ( P =.025), chronic kidney disease ( P =.004), or diabetes ( P =.003). This study supports broadening indications for outpatient TJA because we found a shift toward older patients with more comorbidities successfully undergoing the procedure. [ Orthopedics . 2023;46(5):303–309.]