Patients who undergo a total knee arthroplasty (TKA) on an outpatient basis tend to experience higher rates of certain complications, including infections, repeat surgery, and blood clots, compared to traditional inpatient surgery, according to UCLA researchers.

Using a US insurance database, a team of researchers led by Armin Arshi, MD, from the David Geffen School of Medicine at UCLA, identified two groups of patients who had a TKA procedure between 2007 and 2015. About 4,400 patients underwent TKA on an outpatient basis, generally sent home on the same day as surgery. Another 129,000 patients underwent conventional inpatient TKA, typically staying in the hospital for 1 or more days after surgery.

In their study, published in The Journal of Bone & Joint Surgery, Arshi and his team compared the complication rates over 1 year between both groups. The patients in both groups had a median age between 70 and 74 years, but based on a standard “comorbidity” score, the outpatient TKA group had fewer accompanying medical problems.

Several joint-related and medical complications were more frequent after outpatient TKA, according to the researchers. The most common complication—knee pain and stiffness requiring joint manipulation with the patient under anesthesia—occurred in 4.24% of patients undergoing outpatient TKA versus 3.57% of the inpatient TKA group. After adjustment for age, sex, and comorbidity, outpatient TKA patients had a relative 28% increase in the risk of this complication.

Outpatient TKA was also associated with relative increases of 50% in surgical infections requiring irrigation and debridement, 22% in repeat surgery due to causes other than infection, and 35% in removal of the knee prosthesis, explains a media release from Wolters Kluwer Health: Lippincott Williams and Wilkins.

Two medical complications were also more frequent in the outpatient TKA group, the release continues. The 60-day risk of deep vein thrombosis, a blood clot-related complication, was 42% higher, relative to inpatient TKA. There was also a small but significant 13% increase in the 14-day risk of acute kidney failure.

The findings point to some important “clinical pathways for realizing the potential for safe and effective outpatient arthroplasty,” the researchers note.

“The findings are particularly important to patients who may want to ask their surgeon whether or not they are medically optimal candidates for outpatient surgery and whether they will receive the standard antibiotic and thromboembolism prophylaxis protocols postoperatively,” Arshi comments, in the release.

“We also recommend that they consider plans for physical therapy and rehabilitation after discharge, and in particular whether they will have adequate access to important rehabilitation at home during the important early postoperative period,” he adds.

[Source(s): Wolters Kluwer Health: Lippincott Williams and Wilkins, Newswise]