The Effect of Surgical Approach on the Outcomes of Same Day Discharge Outpatient Total Hip Arthroplasty at a Single Ambulatory Surgery Center.

BACKGROUND: Primary total hip arthroplasty (THA) is increasingly being performed in the outpatient setting. However, there is little known regarding the differences in same-day discharge rates and complications of operative approach in same-day total hip arthroplasty in the ambulatory surgery center (ASC) setting.

METHODS: A retrospective chart review was performed between July 2019 and October 2021 for all patients who underwent primary THA in a single freestanding ASC. Successful same-day discharges, surgical approaches, lengths of surgery, estimated blood losses (EBL), complications, and readmission events were recorded for each patient. Complications were compared using Pearson Chi-Squares, while EBL and surgery lengths were compared with one-way analysis of variances (ANOVA) (alpha=0.5). There were 17 total complications in 326 total hip arthroplasties (5.2%), including direct admissions to the emergency department, 30- and 90-day readmissions, wound complications, instability, infection, and revision surgery. Among all complications there were 5 direct admissions, making the successful same-day discharge rate 98.5%.

RESULTS: Complications and direct admissions were not associated with approach. The 30-day readmission rates were associated with approach, with no readmissions in the direct anterior approach (DAA) or the antero-lateral approach (AL) cohorts and 3 (4.3%) in the posterior approach (PA) cohort.

CONCLUSION: In the ASC setting, patients undergoing THA regardless of approach showed no difference in successful same-day discharges or complications aside from 30-day readmissions. Same-day THA can be safely performed in the DAA, AL, and PA approaches to the hip.