Abstract
Introduction
Outpatient total joint arthroplasty (TJA) is emerging as a viable alternative to the historically accepted hospital-based inpatient TJA in the United States. Several studies have focused on the financial advantages of outpatient TJA, however little research has discussed patient reported outcome measures (PROM) and the overall patient experience. The purpose of this study is to compare PROM data in patients undergoing outpatient vs. inpatient total knee arthroplasty (TKA) performed in the first year of a newly opened outpatient facility.
Methods
An internal quality metric database analysis was performed on patients undergoing TKA between 2/14/14 and 5/1/2015. Outpatient TKA was performed at an ambulatory surgery center. Three-hundred and forty-three TKA patients (both inpatient and outpatient) between the ages of 37–65 years old were included. The Oxford Hip, VAS Pain, and Treatment Satisfaction Questionnaires were completed pre-operatively, and at 3- and 6-months post-op.
The Treatment Satisfaction Questionnaire asks 8 questions including “how well did the surgery on your joint increase your ability to perform regular activities?” Patients chose from poor, fair, good, very good, and excellent. Chi-squared analyses determined differences in percentages between outpatient and inpatient PROM. Independent samples t-tests determined significant improvements between pre-op and 6 month post-op PROM scores.
Results
Outpatients showed a significantly higher improvement in VAS pain score at 6 months compared to inpatients (74.5% vs. 61.6%, p<0.01).
Outpatients rated their pain relief as “very good-to-excellent” significantly higher than inpatients (90.0% vs. 74.0%, p=.020) at 6 months post-op.
Outpatients rated their ability to perform regular activities as “very good-to-excellent” more frequently as inpatients (82.0% vs. 59.3%, p=.004) at 6 months post-op. This difference was significant.
A significantly higher percentage of outpatients reported “very good-to-excellent” meeting of expectations compared to inpatients (82.0% vs. 63.4%, p=.017) at 6 months post-op.
No statistical difference was found between outpatients and inpatients in terms of Oxford Knee (function) scores at 6 months post-op.
No statistical differences between the inpatient and outpatient groups were noted at the 3 month post-op time point.
Conclusion
Significantly greater improvement was reported by outpatient TKA patients vs. inpatient TKA patients at six months post-op. Outpatients report a greater improvement on the VAS Pain score, and report a higher frequency of top-box ratings on the TKA normal joint and TKA satisfaction questionnaires. The implementation of outpatient TKA procedures shows greater overall patient satisfaction and improvement 6 months post-operation. This study illustrates that a de novo outpatient TJA pathway and facility can be successfully implemented with very high levels of patient satisfaction and patient reported success.
