Can primary total hip arthroplasty be performed in an outpatient setting? Prospective feasibility and safety study in 321 patients in a day-surgery unit

Abstract

IntroductionTotal hip arthroplasty (THA) performed as day-surgery is an emerging and growing practice. The main aim of the present study was to assess the feasibility and safety of primary THA in an outpatient setting. The study hypothesis was that, within a specifically dedicated structure, such surgery is feasible and safe. Material and methodsA prospective observational study was performed in two centers, one private hospital and one university hospital, including all patients operated on by two senior surgeons between 2014 and 2017 for primary THA and eligible for day-surgery. The clinical pathway was governed by a pre-established protocol. Preoperatively, all patients took part in an information workshop, with their spouses and the surgeon. Postoperative phone interviews were held on D1 and D3, then out-patient consultations were conducted at 1 and 6 weeks. The main study endpoint was successful outpatient management, failure being defined as crossover or readmission within 1 week of discharge. Secondary endpoints comprised complications rate and satisfaction as assessed by patient and spouse at 6 weeks. ResultsDuring the study period, 1,303 patients received primary THA. 338 (25.9%) were eligible for day-surgery, but 17 (5%) declined; the day-surgery series thus comprised 321 patients (24.6%): 166 men, 155 women; mean age, 61.2±9.7 years. Same-day discharge was not possible for 14 patients (4.5%): 9 due to persistent faintness, 2 to intraoperative femoral fracture, 1 to organizational issues, 1 to an uncomplicated fall, and 1 to hemoglobinemia<11g/100ml in a coronary patient. There were no readmissions during week 1. At 6 weeks’ follow-up, there had been 3 adverse events: 2 dislocations, and 1 periprosthetic fracture. 312 patients (97.2%) were satisfied. ConclusionThe present prospective study found no major adverse events in patients undergoing day-surgery for primary THA. However, patients should be selected, consenting, prepared and managed on a standardized clinical pathway. Level of evidenceIV; non-comparative prospective study.