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. This is a retrospective comparison of PROM data in patients undergoing outpatient vs. inpatient total hip arthroplasty (THA).
Methods
An internal quality metric database analysis was performed on patients undergoing THA between 2/14/14 to 5/1/2015. Outpatients underwent THA at a newly opened ambulatory surgery center. Inpatients underwent THA in a hospital setting. Ninety-six outpatients and 152 inpatients between the ages of 29–65 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 asked 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 3 month post-op PROM scores.
Results
Outpatients reported significantly greater improvements in functionality at 3 months post-operatively compared to inpatients (20.9 vs. 17.0 raw score improvement) as assessed using the Oxford Hip Score Questionnaire. Thus, outpatients showed a 23% greater improvement compared to inpatients. This was statistically significant (p<0.01).
Outpatients showed a significantly higher improvement in VAS pain score compared to inpatients (84.5% vs. 66.2%, p<0.01) at 3 months post-op.
Outpatients reported a significantly higher score (on a 100 point scale) when rating how normal their joint felt (85.0 vs. 76.8, p=.022) at 3 months post-op.
A significantly higher percentage of outpatients reported their pain relief as “excellent” compared to inpatients (71.7% vs. 56.3%, p<0.01) at 3 months post-op.
A significantly higher percentage of outpatients reported their ability to perform regular activities as “excellent” compared to inpatients (57.7% vs. 30.6%, p=.002) at 3 months post-op.
A significantly higher percentage of outpatients reported their ability to perform regular activities as “very good-to-excellent” compared to inpatients (82.7% vs. 65.9%, p=.033) at 3 months post-op.
A significantly higher percentage of outpatients reported that they “definitely would” have surgery again compared to inpatients (84.6% vs. 69.4%, p=.046) at 3 months post-op.
Conclusion
Significantly greater PROM and VAS pain score improvements were reported by outpatient THA patients vs. inpatient THA patients of similar age between the pre-operative time point and 3-months post-op. Outpatient THA patients report a greater improvement on the Oxford Hip Score scale, VAS pain score, THA normal joint, and THA satisfaction questionnaire. The implementation of outpatient THA procedures shows greater overall patient satisfaction and improvement 3 months post-operation. This study demonstrates our initial experience with outpatient THA. The results have met and/or exceeded the inpatient experience with regards to patient reported outcomes measures.
