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Outpatient Orthopedic Surgery: Recover Faster at Home with Your New Knee or Hip

Advancements in orthopedic surgery, notably total hip and knee replacements, have come a long way. Rather than laying in a hospital bed for weeks, patients can now recover in the comfort of their home and most often begin walking within hours of surgery.

With new advances in technology that promote faster recovery, outpatient orthopedic surgery offers many advantages to patients:

  • Higher Satisfaction: Overall, patients prefer outpatient surgery over inpatient and report high satisfaction rates.
  • Better Recovery: Most patients will recover with more ease in the comfort of their own home and get a better night’s sleep, which is essential for recovery.
  • Less Pain: A spinal injection will numb you from the waist down for up to two hours. A long-lasting local anesthetic called a “nerve block” will help control your pain for up to two days post-surgery.
  • Physical Therapy: You will begin working with a physical therapist within a day of returning home after surgery to begin to restore full function to the joint.
  • Lower Infection Risk: The research shows that many infections are acquired in the hospital setting. The less time you spend there, the less risk for infection.
  • Fewer Complications: Research does not show a significance difference in post-surgical complications for outpatient versus inpatient surgery. And some data shows fewer complications with outpatient surgery.

Let’s take a look at the research to support these benefits.

Outpatient Orthopedic Surgery: What the Research Tells Us

Patient Satisfaction

The medical journal Orthopedic Reviews published the results of researchers systematic review of Medline, Pubmed and Embase medical databases for articles comparing the clinical and economic impact of outpatient orthopedic surgical procedures versus inpatient procedures in North America. Researchers found several areas where outpatient orthopedic surgical procedures have potential benefits over inpatient procedures, including patient satisfaction.

The review demonstrated that outpatient surgery participants reported increased satisfaction with the care they received. Additionally, patients reported similar or improved level of pain and rates of nausea with outpatient procedures.

As expected, researchers also found that outpatient procedures were less expensive than inpatient procedures. They noted that outpatient procedures in North America appear to be less expensive and a safe alternative to inpatient care for patients who are at lower risk for complications and procedures that do not necessarily require close hospital level care monitoring following same day surgery. In conclusion, this study of such a large patient population suggests that patients who underwent outpatient orthopedic surgeries did not have to trade quality of care for cost savings. [1]

Another study in The Journal of Foot and Ankle Surgery demonstrated that outpatient total ankle arthroplasty may be a better option than inpatient surgery for certain patients. Researchers used the National Surgical Quality Improvement Program database to examine data from 66 outpatients and 535 inpatients who had undergone total ankle arthroplasty. Postoperative complication rates for surgical site infections, hematologic complications and operating room readmissions were compared between the two patient groups. Seventy-one percent of outpatients and 93 percent of inpatients said they were satisfied with their choice to undergo surgery in their respective settings.[2]

Provider Satisfaction
With regard to care specific to the surgeon in the outpatient setting, The Press Ganey® Outpatient Medical Practice Survey (PGOMPS) – composed of 10 provider-specific and 15 non-provider-specific questions – reviewed all new patient orthopedic PGOMPS scores between January 2014 and December 2017 (5,163 patients). The data revealed that among orthopedic outpatients, the majority of patients were satisfied with their provider, demonstrating that room for improvement is limited with provider-specific areas.[3]

Fewer Complications and Hospital Readmissions
In a study looking at 90-day complication rates and 2-year patient-reported outcomes of outpatient versus inpatient hip arthroplasty, researchers found that in appropriately selected patients, outpatient total hip arthroplasty can achieve improved postoperative 2-year patient reported outcomes compared to inpatient total hip arthroplasty. Researchers found no differences regarding postoperative short-term complications or 2-year revision rates, and no differences in unplanned office visits or readmissions.[4]

Another study using a large claims database of non-Medicare patients examined inpatient and outpatient total knee replacement and total hip replacement surgery performed in a near-elderly population from 2014-2016. Researchers found that postsurgical complications were lower for outpatients than for inpatients. Readmissions were also lower for the outpatient group.[5]

In a study in the Journal of Arthroplasty, research demonstrated that outpatient, short-stay total hip arthroplasty is safe for select Medicare-aged patients. Researchers looked at data on patients who underwent primary total hip arthroplasty between 2015 and 2016, comparing 30-day complications, readmission and reoperation rates for inpatient, outpatient and short-stay groups. They concluded that patients who underwent outpatient surgery or were short-stay patients had lower 30-day readmission and complication rates than the inpatient groups.[6]

Cost of Care: Outpatient vs Inpatient
Medical costs continue to increase year-over-year – and patients continue to feel the burden of those rising costs more and more.

Research from New York City-based Hospital for Special Surgery and Philadelphia-based Rothman Orthopaedic Institute compared hip and knee replacement surgeries. In the study, there were 126 patients in both the ASC and hospital groups, with 77 patients undergoing total hip replacements and 49 undergoing total knee replacements. Data revealed that on average, outpatient surgery costs were 40 percent less than inpatient surgery costs.[7]

The Journal of Shoulder and Elbow Surgery found patient-level costs for primary elective inpatient total shoulder arthroplasty to be higher than those for outpatient procedures. Researchers used the Texas Health Care Information Collection database to analyze outpatient and inpatient total shoulder arthroplasties performed between 2010 and 2015 for patient-level costs determined by whether a surgery center was inpatient or outpatient, as well as a center's volume. The study found inpatient costs were significantly higher than outpatient costs for total shoulder arthroplasty, at $76,109 and $22,907, respectively.[8]

Is Outpatient Surgery Right for You?

There are many benefits to orthopedic outpatient surgery for you as a patient, if you are a candidate for it.
You’re a strong candidate for outpatient surgery and its benefits if you are:

  • Mobile – If you’re someone who has been active and independent before surgery, you’ll likely respond well to post-op physical therapy. Additionally, you’ll be ready to resume your daily activities as soon as possible.
  • Healthy – If you are generally a healthy person taking few medications, you are likely a good candidate for outpatient surgery.
  • Motivated – If you have a positive attitude and are willing to follow your doctor’s post-surgery instructions and work diligently with your physical therapist, you are a strong outpatient candidate.
  • Supported – Having someone at home to help care for you after surgery is important.

In the event that you are not a candidate for outpatient orthopedic surgery, but want to avoid the hospital setting, our new surgery center is an ideal option for you. We offer options for overnight stay with 24-hour care for those who require it.

In Conclusion
Orthopedic surgery has advanced tremendously in the last decade with new technologies, including robotics, that provide surgeons with advanced tools for improving patient recovery and outcomes. These advances make outpatient orthopedic surgery a viable, safe and effective option for many patients – and one many patients prefer.

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[1] Crawford, Dennis C., Silvia Li, Chuan, Sprague, Sheila, Bhandari, Sheila. Clinical and Cost Implications of Inpatient Versus Outpatient Orthopedic Surgeries: A Systematic Review of the Published Literature. Orthopedic Reviews. 2015 Dec 28; 7(4): 6177.

[2] Chandler, Tedder MS, DeBell BS, Henry, Dix BS, Daniel, R. Mith BS, Walter, McGwin Jr. MS, PhD, Gerald, Shah MD, Ashish, Naranje MD, Sameer. Comparative Analysis of Short-Term Postoperative Complications in Outpatient Versus Inpatient Total Ankle Arthroplasty: A Database Study. The Journal of Foot and Ankle Surgery. Volume 58, Issue 1, January 2019, Pages 23-26

[3] Stephens, Andrew R., Rowberry, Tyson J., Tyser, Andrew R., Kazmers, Nikolas H. Evaluating opportunities for improved orthopedics outpatient satisfaction: an analysis of Press Ganey® Outpatient Medical Practice Survey responses. Journal of Orthopaedic Surgery and Research. Volume 15, Article number: 28 (2020).

[4] Rosinsky, P.J., Chen, S.L., Yelton, M.J. et al. Outpatient vs. inpatient hip arthroplasty: a matched case-control study on a 90-day complication rate and 2-year patient-reported outcomes. J Orthop Surg Res 15, 367 (2020).

[5] Carey PhD, Kathleen, Morgan PhD, JR, Lin PhD, MY, Kain MD, MS, Creevy, MD, WR. Patient Outcomes Following Total Joint Replacement Surgery. The Journal of Arthroplasty. Volume 35, Issue 1, p7-11, January 01, 2020.

[6] Greenky MD, M. R., Wang MD, William, Ponzio MD, D.Y., Courtney MD, Maxwell.
Total Hip Arthroplasty and the Medicare Inpatient-Only List: An Analysis of Complications in Medicare-Aged Patients Undergoing Outpatient Surgery. Journal of Arthroplasty. Volume 34, Issue 6, June 2019, Pages 1250-1254.

[7] Hospital for Special Surgery. No increased risk of complications for joint replacement in ambulatory surgery center. https://www.eurekalert.org/pub_releases/2019-03/hfss-nir031319.php

[8] Gregory MD, James M., Wetzig BS, Alexander M., Wayne BS, Colton D., Bailey PT, PhD, Lane, Warth MD, Ryan. Quantification of patient-level costs in outpatient total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. Volume 28, Issue 6, June 2019, Pages 1066-1073

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