Abstract

Total Knee Arthroplasty (TKA) in the Outpatient setting has increased in recent years due to the appeal of lower cost, and higher patient satisfaction. However, some literature reports an increased rate of complication with outpatient TKA. In this nationwide survey of patients who have received a TKA, no statistically significant difference was found in the patient reported rate of complication.

Introduction​​​​​​
The number of total knee arthroplasty procedures in the U.S. is estimated to increase from 600,000 to 935,000 per year by 2030. Outpatient surgery centers over the last few decades have been increased in number and use, allowing for same day discharge in TKA instead of the traditional 3-4 day hospital stay. Outpatient surgery can decrease patient cost and increase patient satisfaction. However, recent literature has mixed reports on rate of complication and outcome in outpatient vs. traditional hospital performed TKA.

Methodology
A nationwide survey of patients who received a TKA was deployed. This survey consisted of 19 questions to determine rate of complications and overall patient satisfaction with the TKA. A composite score for each patient was calculated by adding the differences of the post and pre TKA values for pain and stiffness. 

Results
There were no significant differences found between in-hospital and OSC groups in surgical complications (p=0.358), infections (p=0.658), willingness in undergo surgery again (p=0.186), postoperative composite scores (pain, stiffness, exercise ability; p=0.888), or overall TKA satisfaction. Variation in time between surgery and survey may have introduced hindsight bias. 

Conclusion
When comparing patient satisfaction between TKA performed in a hospital vs. an outpatient surgery center, we found comparable results, with no significant difference in complications or satisfaction. This aligns with the most current literature comparing the two surgical modalities. With the projected increase in TKA by 2030, outpatient surgery centers may prove to be a viable and safe option for the increase in demand.