Octogenarians Rockin’ Same-Day TKA?

Is concern for octogenarians who have total knee arthroplasty (TKA) in an outpatient setting justified? Citing a rise in such surgeries, and given the paucity of data on this, a multicenter team took a look at the risk of complications and readmissions following outpatient TKA in patients ≥80 years old.

The study, “Same-Day Discharge Total Knee Arthroplasty in Octogenarians,” appears in the August 17, 2022, edition of The Journal of Arthroplasty.

“Given the potential benefits of outpatient TKA including lower healthcare costs and higher patient satisfaction, we are continuing to work to refine appropriate patient selection,” Nathan Varady, M.D., M.B.A., co-author and orthopedic resident at Hospital for Special Surgery in New York, told OTW. “The need for this has been only furthered by the COVID-19 pandemic and the associated need to minimize inpatient resource utilization as well as potential inpatient exposure to the virus.”

Using data from the National Surgical Quality Improvement Program database (2011 to 2019), the researchers matched patients ≥80 years undergoing inpatient TKA to patients ≥80 years old having outpatient TKA. Patients were matched on age, sex, race, body mass index, American Society of Anesthesiologists classification, functional status, smoking status, anesthetic type, and comorbidities. Each group had 709 patients; 30-day complications, readmissions, reoperations, and mortality were analyzed.

Dr. Varady and his colleagues found that 30-day readmission rates were the same between those who had outpatient and inpatient surgery (3.5% vs. 3.5%). It was the same with major complications (2.7 vs. 2.0%), reoperations (1.3 vs. 0.8%, or mortalities (0.3 vs. 0.3%) within 30 days.

“The most important result,” said Dr. Varady to OTW, “was that readmission rates were essentially identical between octogenarian patients who underwent outpatient TKA compared to their matched inpatient TKA counterparts. That is not to say outpatient TKA is the correct option for all octogenarians—it certainly is not. Rather, these findings suggest that it does not need to be contraindicated for all octogenarians; there are certain, carefully selected octogenarians for whom outpatient TKA is likely a good option.”

“Many institutional protocols for outpatient TKA currently list age ≥80 years as a contraindication to outpatient TKA. In our experience, this rule is often applied even in the absence of an institutional requirement. The current study suggests that these rules may be softened; outpatient TKA does not need to be uniformly contraindicated in all octogenarians.”