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Large Joints Feature

Source: Wikimedia Commons and Tim Evanson

Is Outpatient Total Knee Arthroplasty Safe?

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, February 26th, 2018

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Now that Medicare is on board with outpatient total knee arthroplasty (TKA) reimbursement, researchers wanted to explore the issue of safe discharge in this population. Their work, “Can Total Knee Arthroplasty Be Performed Safely as an Outpatient in the Medicare Population?” was published in the January 15, 2018 edition of The Journal of Arthroplasty.

P. Maxwell Courtney, M.D., hip and knee surgeon at Rothman Institute, Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, and co-author on the study told OTW, “While many privately insured patients have successfully undergone outpatient total knee replacements, Medicare would not reimburse facilities for an outpatient procedure until this year.”

“This has been a ‘hot button’ issue recently, with many patients and surgeons believing that Medicare beneficiaries can safely go home the same day following a knee replacement at a lower cost ambulatory surgical facility. Concerns exist, however, about an increased complication rate in this older population with more medical comorbidities.”

“We have yet to determine the optimal, safe, length of stay in the Medicare population.”

The authors wrote, “We queried the American College of Surgeons-National Surgical Quality Improvement Program database for patients over age 65 years who underwent TKA from 2014 to 2015. Demographics, comorbidities, 30-day complications, and readmission rates were compared between patients after outpatient, short-stay, and inpatient procedures…Of the 49,136 Medicare-aged TKA patients, 365 were outpatient, 3,033 were short-stay and 45,738 were inpatient.”

Dr. Courtney told OTW, “We found that Medicare patients who were discharged home on postoperative day one had a lower complication rate than both the same day discharge and the inpatient stay group. This suggests that a ‘sweet spot’ of a 24-hour period of observation may be appropriate for most Medicare patients. We also found that a certain subset of younger, healthier Medicare beneficiaries could undergo an outpatient knee replacement safely. More prospective studies are needed to evaluate the CMS [Centers for Medicare and Medicaid Services] move to remove total knee replacement from the inpatient only list.“

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