Safety And Efficacy Of Outpatient Total Hip Arthroplasty:a Propensity Score-matched Study

BackgroundTotal hip arthroplasty(THA)is the most effective method for the treatment of various hip diseases at the end stage.Since the new century,the surgical model of Outpatient total hip arthroplasty(oTHA)has been constantly developed and improved in foreign countries.Compared with Inpatient total hip replacement surgery(i THA),oTHA can effectively improve the utilization rate of medical resources in medical institutions,reduce the medical costs of patients,and reduce the payment pressure of medical insurance.It also has similar safety and efficacy to i THA mode.In recent years,with the development of domestic THA related surgical techniques,new concepts and perioperative management,especially the continuous popularization and deepening of the concept of enhanced recovery after surgery,THA in China has developed towards minimally invasive and rapid development,which has laid a solid foundation for the development of oTHA in China.ObjectiveTo evaluate the safety and efficacy of oTHA,the hospital costs,reoperation,readmission,complications,emergency department visits and unscheduled outpatient visits within 90 days after operation,perioperative blood management,and hip related functional scores were compared and analyzed between oTHA and propensity score-matched(PSM)i THA patients.MethodsA total of 412 THAs(118 cases of oTHA and 294 cases of i THA)were performed by one joint surgeon from December 2019 to December 2021.General clinical data of patients were collected,including gender,age,American Society of Anesthesiologists(ASA)classification and body mass index(BMI).Among them,118 oTHA patients were PSM with 118 i THA patients in the same period according to age,ASA classification,and BMI.Retrospective analysis: reoperation,readmission,complications,number of emergency visits,and unplanned outpatient visits within 90 days after surgery in the two groups;It was observed that the total cost of hospitalization,along with the cost after removal of artificial implants,as well as the levels of hemoglobin(Hb)and hematocrit(Hct)during the perioperative period changed.Prior to surgery,6 weeks,3 months,and 1 year after surgery,the harris hip score(HHS)and the oxford hip score(OHS)were evaluated.In addition,the forgotten joint score(FJS)has to be calculated at 6 weeks,3 months,and 1year after surgery.And the delayed discharge of oTHA patients was counted.ResultsThe preoperative general clinical data of the two groups were similar,reflecting successful propensity matching.The rates of reoperation and readmission were both 1.7%(P = 1.000,P = 1.000),the incidence of emergency department visits was 1.7% and 2.5%(P = 1.000),and the incidence of complications was 5.9% and 6.8%(P = 0.790)in oTHA and i THA groups,respectively.Dislocation after THA occurred in 1 case in each group(P= 1.000).The above data did not show a significant difference between the two groups.In terms of unscheduled clinic visits,differences in the incidence of unscheduled clinic visits in the oTHA and i THA groups(13.6% VS 4.2%,P = 0.012),the incidence of unscheduled clinic visits in the first 59 and last 59 cases of oTHA group(20.3% VS 6.8%,P = 0.012),and the incidence of unscheduled clinic visits in the first 59 of oTHA group and i THA group(20.3% vs 4.2%,P = 0.01)were statistically significant,but in the last 59 cases of oTHA group and i THA group(6.8% VS 4.2%,P = 0.717)there was no significant difference.The total cost of hospitalization((?)88419.23±7475.40 vs (?)94466.34±7567.39)and the total cost after removal of artificial implants((?)18916.65±2018.57 vs (?)23683.32±3245.63)in oTHA group and i THA group were statistically different(P < 0.001,P < 0.001).For the oTHA and i THA groups,the preoperative Hb(138.8±13.5g/L,138.6±15.6g/L)and Hct(41.82±3.75%,41.90±4.32%)levels(P = 0.933,P = 0.884),the Hb(109.9±13.5g/L,108.0±13.9g/L)and Hct(33.22±3.87%,32.74±3.94%)levels on the first day after operation(P = 0.304,P = 0.338),and the difference of Hb(28.9±7.8g/L,30.6±8.7g/L)and Hct(8.60±2.32%,9.16±2.72%)from preoperative to postoperative day 1(P = 0.119,P = 0.088)were not significantly different between the two groups.Neither group of patients had deep vein thrombosis(P = 1.000).One patient in the oTHA group needed blood transfusion after operation(P = 1.000).Intermuscular thrombosis occurred in 2 cases in oTHA group and 1case in i THA group(P = 1.000).The OHS scores of the hip joints at the four time points in the oTHA and i THA groups were: Preoperative 44.2±6.1 vs 44.5±6.8(P = 0.733),postoperative 6 weeks30.1±4.4 vs 30.3±4.4(P = 0.648),postoperative 3 months 22.9±3.4 vs 23.1±3.2(P =0.713),17.4±3.4 vs 17.7±3.1(P = 0.599)at 1 year after surgery.There was no significant difference between the two groups,and the scores became better with the extension of follow-up time,with the same trend of change(P = 0.911).Similarly,the FJS score of the artificial hip in the two groups at the three time points were: at postoperative 6 weeks(48.93±8.82 vs 48.63±9.18,P = 0.768),postoperative 3 months(64.45±8.52 vs 63.47±7.43,P = 0.275),and 1 year after surgery(93.56±3.17 vs 93.33±4.09,P = 0.620).There was no significant difference between the two groups,and the change trend was consistent(P =0.241).In addition,the HHS scores of the two groups were 43.3±10.2 and 42.8±10.4before surgery(P = 0.695),87.3±5.0 and 86.7±4.7 at 3 months after surgery(P = 0.281),and 94.4±4.1 and 94.1±3.9 at 1 year after surgery(P = 0.450),respectively.The mean HHS score at 6 weeks after surgery was 72.4±6.7 in the oTHA group and 70.8±6.8 in the i THA group,and the difference between the two groups was statistically significant(P = 0.033).The overall trends of HHS scores were similar between the two groups(P = 0.711).There were 9 cases of delayed discharge in all 118 oTHA patients,and the delayed discharge rate was 7.6%.There were 2 cases of postoperative incision bleeding,2 cases of postoperative persistent hypotension,1 case of postoperative urinary retention,1 case of postoperative obvious pain,1 case of postoperative low fever,1 case of postoperative nausea and vomiting,and 1 case of postoperative dizziness and headache.ConclusionThe results of our study showed that when appropriate oTHA patients were selected,there were no significant differences in reoperation,readmission,complications,emergency department visits within 90 days,hip function recovery,and joint adaptability after surgery between oTHA patients and propensity matched i THA patients,except for the unscheduled outpatient visit,which eventually disappeared as the medical team gained experience.But,the hospitalization costs of oTHA patients were significantly lower than those of i THA patients.Compared with traditional i THA,oTHA has similar safety and efficacy,and can reduce hospitalization costs.