Comparison of outpatient versus inpatient total hip and knee arthroplasty: A systematic review and meta-analysis of complications

Introduction: Patients undergoing TKA or THA have traditionally been managed post-operatively as inpatients. However, with current surgical techniques and pain management, there is evidence that outpatient joint arthroplasty can be safely performed in selected patient. This systematic review and meta-analysis aimed to compare the post-operative complication rates of outpatient and inpatient TJA with subgroup analysis of TKA and THA. Methods: Electronic searches were performed using five databases from their date of inception to October 2018. Relevant studies were identified, with data extracted and meta-analyzed from the studies. Results: From seven included studies, 176,179 patients were inpatient TJA and 1613 were outpatient TJA. The outpatient and inpatient TJA cohorts had similar mean age and BMI, with a greater proportion of females in the inpatient group. For TJA we found no significant difference in total complications (P = 0.06), major complications (P = 0.59), readmissions (P = 0.60), DVT (P = 0.94), UTI (P = 0.50), pneumonia (P = 0.42) and wound complications (P = 0.50) between the outpatient and inpatient groups. However, there were fewer transfusions (P = 0.05) but increased reoperations (P = 0.02) in the outpatient TJA group. Subgroup analysis of TKA (P = 0.25) and THA (P = 0.39) also found no significant differences in total complications between the outpatient and inpatient groups. Conclusion: Outpatient TJA had comparable total complication rates to inpatient TJA. Along with that outpatient TJA can significantly reduce costs to healthcare systems but careful pre-operative patient selection is required to optimize outcomes. More quality randomized controlled trials with longer follow-up periods are needed to add to this body of evidence.