Outpatient Hip Safety in an Ambulatory Surgery Center Is Independent of Approach

Zachary K. Pharr, MD1 Carson M. Rider, MD2 Jack W. Bell, BS3 James H. Wilde, BS3 Timothy J. Westbrooks, BS4 Patrick C. Toy, MD1

1 University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering Memphis, Tennessee 2 Foot Ankle Fellowship

Hospital for Special Surgery

New York, New York 3 University of Tennessee

Health Science Center

College of Medicine

Memphis, Tennessee 4 Orthopaedic Surgery

University of Kentucky

Lexington, Kentucky

Corresponding Author

Patrick C. Toy, MD

1458 W. Poplar Avenue, Suite 100 Collierville, TN 38017 P: 901-759-5537 F: 901-435-5653 ptoy@campbellclinic.com

ABSTRACT

Background

There are few data comparing the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in the outpatient setting. The purpose of this study is to compare 90-day complications between the 2 approaches. We hypothesized that they would be equally safe and e ective.

Methods

Retrospective review identified 432 THAs (346 DAA, 86 PA) performed at a single ambulatory surgery center (ASC). Outcomes compared included demographics, comorbidities, preoperative and discharge pain scores (visual analog scale [VAS]), overall time spent in the ASC, overnight stay, emergency room visits, admission, reoperation, and complications within a 90-day period.

Results

There were no di erences in mean preoperative VAS (DAA 4.7, PA 4.5), mean discharge VAS (DAA 0.8, PA 0.7), overall time spent in the ASC (DAA 9.0 hours, PA 9.3 hours), total number of overnight stays (DAA 0.9%, PA 1.2%), emergency room visits (DAA 1.7%, PA 1.2%), admissions (DAA 1.4%, PA 1.2%), reoperations (DAA 1.4%, PA 1.2%), or complications (DAA 3.5%, PA 2.3%).

Conclusion

There were no di erences in the safety outcomes, and overall there were few complications in the 90-day period, regardless of the surgeon’s preferred approach. This study indicates both DAA and PA are equally safe for THA in the outpatient setting, and the choice of surgical approach should be based on patient and surgeon preference.