Outpatient total knee arthroplasty leads to a higher number of complications: a meta-analysis
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(2020) 15:408
SYSTEMATIC REVIEW
Open Access
Outpatient total knee arthroplasty leads to a higher number of complications: a metaanalysis Vittorio Bordoni1†, Alberto Poggi2*†, Stefano Zaffagnini2, Davide Previtali1, Giuseppe Filardo3 and Christian Candrian1
Abstract Background: Careful pre- and post-operative management can allow surgeons to perform outpatient TKA, making this a more affordable procedure. The aim of the present meta-analysis is to compare outpatient and inpatient TKA. Methods: A systematic search of the literature was performed in July 2020 on PubMed, Web of Science, Cochrane library, and on the grey literature databases. The papers collected were used for a meta-analysis comparing outpatient and inpatient TKA in terms of complication and readmission rates. Risk of bias and quality of evidence were defined according to Cochrane guidelines. Results: The literature search resulted in 4107 articles; of these, 8 articles were used for the meta-analysis. A total of 212,632 patients were included, 6607 of whom were TKA outpatients. The overall complication rate for outpatient TKAs was 16.1%, while inpatient TKAs had an overall lower complication rate of 10.5% (p = 0.003). The readmission rate was 4.9% in outpatient TKAs and 5.9% in inpatient TKAs. Only 3 studies reported the number of deaths, which accounted for 0%. The included studies presented a moderate risk of bias, and according to GRADE guidelines, the level of evidence for complications and readmissions was very low. Conclusions: This meta-analysis documented that outpatient TKA led to an increased number of complications although there were no differences in the number of readmissions. However, future high-level studies are needed to confirm results and indications for the outpatient approach, since the studies currently available have a moderate risk of bias and a very low quality of evidence. Keywords: Total knee arthroplasty, TKA, Outpatient, Complications
Background Over the past few years total knee arthroplasty (TKA) procedures benefited from an improvement of both surgical and anesthetic techniques, as well as perioperative care [1, 2], making it possible not only to improve * Correspondence: [email protected] The study was performed at Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, CH † Dr. Bordoni and Dr. Poggi have contributed equally to this article and share first authorship. 2 II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy Full list of author information is available at the end of the article
clinical results, but also to reduce hospitalization length [3]. The number of surgical procedures increased in the past few years, with 600,000 procedures per year only in the USA, and it is expected to further grow in the future [4–6]. Accordingly, an improvement in the management with a faster recovery and shorter hospitalization could benefit patient in terms of higher satisfaction and better clinical outcomes, as well as society in terms of economic saving [7–10]. Protocol
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