JSES International (Mar 2020)
The transition of total elbow arthroplasty into the outpatient theater
Abstract
Background: Outpatient total joint arthroplasty is increasing in frequency as reimbursement models change. Potential benefits include same-day surgery for patients and decreased exposure to nosocomial pathogens. This study aims to determine if total elbow arthroplasty (TEA) is also trending toward an outpatient setting, and if there is any impact on complication rates as a result. Methods: A retrospective chart review of the American College of Surgeons National Surgical Quality Improvement Program was performed. Specifically, the database was queried for all patients with CPT code 24363 from 2010-2017. The percentage of TEAs performed each year as an outpatient was trended from 2010-2017. Additionally, the complication rate between the inpatient and outpatient cohorts was compared. Results: A total of 524 TEAs were analyzed. Of these, 111 procedures (21.2%) were performed as an outpatient. There was a statistically significant increase in the percentage of outpatient TEAs from 2010-2017 (P = .0016). In 2010, 2.4% of TEAs were outpatient, compared with 34.5% in 2017. The total complication rate trended toward being lower in the outpatient group, but this difference was not statistically significant (P = .08). Conclusions: There is a significant trend toward TEA being performed as an outpatient procedure, with more than one-third currently being performed in this manner. In our study, there was no difference in the complication rate between inpatient and outpatient TEAs; in fact, outpatient TEAs trended toward having a lower complication rate than inpatient TEAs. Taken together, the outpatient setting comprises an ever-increasing segment of TEA without an increase in morbidity to patients.
