Complications of total hip or knee arthroplasty are not significantly more common after ambulatory surgery than after in-patient surgery and enhanced recovery: A case-control study with propensity-score matching

Abstract

BackgroundReluctance to perform total hip arthroplasty (THA) and total knee arthroplasty (TKA) on an ambulatory basis stems from concern that complications might be more common than with enhanced recovery after surgery (ERAS). The objective of this study was to compare the risks of complications, readmission, and reoperation with these two strategies. HypothesisThe complication rate is significantly higher after ambulatory surgery (AS) than with ERAS. Material and methodsConsecutive patients who underwent primary unilateral THA or TKA by two senior surgeons to treat a non-traumatic condition between July 2016 and December 2019 were eligible. We developed a propensity score, which we used to individually match each of the 91 patients managed by AS to the 91 patients managed with ERAS (control group). Follow-up was 3 months. The primary outcome was development of a complication within the first 3 months. Secondary outcomes were complication severity as classified according to Clavien-Dindo, re-admissions within 3 months, and re-operations within 3 months. ResultsComplications were not significantly more common after AS than with ERAS (15% and 11%, respectively, p=0.38). No significant differences were found between the two groups for complication severity (2.9±0.5 versus 2.6±0.8), proportion of re-admitted patients (14% versus 9%), or proportion of re-operated patients (14% versus 9%). DiscussionThe risk of complications was not higher after AS than with ERAS. Reluctance to perform AS due to concern about safety does not seem justified by the evidence. Level of evidenceIII, propensity score-matched case-control study.