An Evaluation of the Safety and Effectiveness of Total Hip Arthroplasty as an Outpatient Procedure: A Matched-Cohort Analysis

J Arthroplasty. 2018 Oct;33(10):3206-3210. doi: 10.1016/j.arth.2018.05.036. Epub 2018 May 31.


Background: Outpatient hip arthroplasty is being performed more routinely; however, safety remains a concern. The purpose of this study was to compare the rate of adverse events of outpatient total hip arthroplasty (THA) and assess barriers to discharge.

Methods: We examined 136 patients who underwent unilateral THA by one surgeon and were discharged on the same day of surgery. Using propensity matching, 136 inpatients who received the same procedure, and were discharged on postoperative day one or later, were identified. For each cohort, 90-day occurrence of adverse events, readmissions, and emergency visits were recorded and compared. Adverse events were graded using the OrthoSAVES tool. A secondary objective was to assess potential barriers to same-day discharge.

Results: Within 90 days postoperatively, 12 outpatients (8.82%) and 14 inpatients (10.29%) developed an adverse event. There were no significant differences between the rate or severity of adverse events between the 2 groups and no serious adverse events in either group. In the outpatient group, there was a correlation between the dosage of spinal anesthetic (bupivacaine) given and time required to stay in postanesthetic care unit postoperatively.

Conclusion: When comparing the 2 groups, there were no differences in adverse events at 90 days. At our center, in the appropriate patient population, outpatient THA is a safe and cost-effective option. A potential barrier to mobility postoperatively and successful same-day discharge is the time required to stay in postanesthetic care unit postoperatively, which was significantly correlated with an increased dose of spinal anesthetic given in our outpatient cohort.

Keywords: adverse events; barriers to discharge; outpatient total hip arthroplasty; same-day discharge; spinal.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Ambulatory Surgical Procedures / adverse effects*
  • Ambulatory Surgical Procedures / economics
  • Ambulatory Surgical Procedures / methods
  • Anesthesia, Spinal / adverse effects
  • Anesthesia, Spinal / methods
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Hip / economics
  • Arthroplasty, Replacement, Hip / methods
  • Arthroplasty, Replacement, Hip / statistics & numerical data
  • Canada / epidemiology
  • Cohort Studies
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Postoperative Complications / epidemiology
  • Propensity Score
  • Treatment Outcome