Abstract
Introduction: Outpatient total hip arthroplasty (THA) is increasingly popular. This meta-analysis investigated the potential advantages of outpatient regimes for THA. Methods: This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus databases were accessed in June 2021. All clinical studies investigating outpatient THA were considered. The outcomes of interest were pain, infection, mortality, revision, dislocation, readmission rates, and deep vein thrombosis (DVT). Results: Data from 102,839 patients were included. A total of 52% (153,168 of 102,839 patients) were women. The mean age of patients was 62.6 ± 4.6 years, the mean BMI was 29.1 ± 1.8 kg/m2. Good comparability was found in age, BMI, and gender (p > 0.1). No difference was found in pain (p = 0.4), infections (p = 0.9), mortality (p = 0.9), rate of revision (p = 0.1), dislocation (p = 0.9), and readmission (p = 0.8). The outpatient group demonstrated a greater rate of DVT (OR 3.57; 95% CI 2.47 to 5.18; p < 0.0001). Conclusions: In selected patients, outpatient THA can be performed safely with optimal outcomes comparable with inpatient THA. Clear and comprehensive pre-operative planning should involve a multi-disciplinary group composed of orthopaedic surgeons, anaesthesia and rehabilitation specialists, and physiotherapists. Each centre performing outpatient THA should implement continuous homecoming welfare activity, to supervise physiotherapy and monitor anticoagulant therapy.
Highlights
Outpatient total hip arthroplasty (THA) is increasingly popular
Outpatient THA remains reserved to a few selected patients: less than 1% of THAs in the United States are performed as outpatient procedures [15,16,17]
The following keywords were used in combination: one day, day surgery, outpatient, inpatient, fast track, arthroplasty, hip, prosthesis, replacement, readmission, revision, stay, hospitalization, deep vein thrombosis, complications, failure
Summary
Outpatient total hip arthroplasty (THA) is increasingly popular. This meta-analysis investigated the potential advantages of outpatient regimes for THA. All clinical studies investigating outpatient THA were considered. Postoperative care after THA has evolved during the past 40 years [3]. Improvement in pain management and bleeding control, regional anaesthesia, direct postoperative full weightbearing, and fast track concepts in hospitalization and rehabilitation have been introduced [1,5,10,11,12]. Outpatient THA remains reserved to a few selected patients: less than 1% of THAs in the United States are performed as outpatient procedures [15,16,17]. The current exclusion criteria for outpatient THA includes heart and vascular diseases, a history of transient ischemic attack, chronic obstructive pulmonary disease, untreated obstructive sleep apnoea, obesity, haemoglobin < 130 g/L, diabetes mellitus, endstage hepatic and/or renal disease, history of delirium or dementia, solid organ transplant, and advanced neoplasm [18,19]
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