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• Posted January 19, 2022

Is a Night in the Hospital Necessary After Hip, Knee Replacement?

For many people undergoing total hip or knee replacement, same-day surgery is a safe option, new research shows.

Among folks in overall good health, the study of nearly 1.8 million patients found similar post-op complication rates among those who had outpatient joint replacement surgery compared to those who spent a night or two in the hospital.

"Careful patient selection is the key to success with outpatient surgery," cautioned senior study author Dr. Geoffrey Westrich, from the Hospital for Special Surgery in New York City.

For example, older age can increase the risk for any surgery, "and so monitoring patients overnight may be beneficial," noted Westrich, research director emeritus of the hospital's adult reconstruction and joint replacement service.

And those with underlying conditions like diabetes or lung disease may also face a higher risk for complications, the research team found. "Inpatient surgery in such patients is probably more safe," added Westrich.

But "there is no doubt that these findings are definitive, and that outpatient surgery is here to stay," he added.

During the 2010-2017 study period, outpatient hip and knee replacements grew by an average of 16% and 11%, respectively, each year, the authors found.

Still, inpatient surgery remains much more common, Westrich acknowledged.

Of the many patients the researchers followed, just under a third underwent total hip replacement, while the remainder had a knee replacement.

When averaged out, only about 3% of knee procedures and just over 2% of hip procedures were handled on an outpatient basis. (By 2017, however, those numbers approached 5% for both.)

Candidates for same-day discharge after knee and hip surgeries were about three and five years younger, respectively, than their inpatient peers. Those who went straight home also had fewer preexisting conditions.

Zeroing in on the risk for complications, researchers looked at adverse events requiring readmission to a hospital within three months after surgery. Potential complications included heart attacks, blood clots, infection, pneumonia, bleeding, and/or mechanical or breakage issues involving the hip or knee prosthetic itself.

Complication rates were essentially the same across all hip replacement patients, whether treated as inpatients or outpatients, the study showed.

Among knee replacement patients, a slightly higher complication risk was seen among those discharged the same day. But even so, the risk was pegged as very small -- less than 1% -- among both those who stayed at the hospital and those who didn't.

"The results are really interesting," said Westrich, "and basically demonstrate that with proper patient selection outpatient surgery can be done safely and can benefit the patient."

Same-day patients still need follow-up, he noted. "All patients at our hospital receive a telephone call the next day to see how they are doing and if they need any help with anything," he said.

But for young, healthy and "highly motivated patients," outpatient surgery can be a good fit, Westrich said.

That message is gaining traction, said Dr. Kanu Okike, an orthopedic surgeon with the Hawaii Permanente Medical Group in Honolulu.

"Over the past several decades, the amount of time that patients spend in the hospital following elective total joint replacement has gradually been decreasing," said Okike, who was not part of the study.

Increasingly, "forward-looking organizations have shown that same-day discharge is feasible and safe for the majority of patients undergoing elective total joint replacement," he said.

Okike echoed Westrich's call for careful patient selection and thorough patient education preoperatively, alongside safe post-op pain control and rigorous follow-up.

"As long as it can be performed safely, many patients prefer waking up in their own bed the morning after surgery," Okike noted. "This has been especially true over the past few years during the COVID-19 pandemic."

The findings were published recently in the Journal of Arthroplasty.

More information

There's more on outpatient joint replacement surgery at the Cleveland Clinic.

SOURCES: Geoffrey H. Westrich, MD, orthopedic surgeon and research director, adult reconstruction and joint replacement service, Hospital for Special Surgery, New York City; Kanu M. Okike, MD, MPH, FAAOS, orthopedic trauma and total hip replacement specialist, Hawaii Permanente Medical Group, Honolulu; Journal of Arthroplasty, Nov. 19, 2021