JOA - 2026-09-21 - Journal Article
Equivalence of Outcomes Between Ambulatory and Hospital-Based Arthroplasty in Younger and Older Adults.
Pang A, Zamzam M, Hodson N, Pellerito A, North T, Charters M
Topics
Key Takeaway
ASC-based TJA in patients ≥75 years showed no significant difference in 90-day readmission (3.6% vs 1.8%, P=0.15) or major complications versus inpatient surgery after propensity score matching.
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Summary
This study compared 90-day outcomes of ASC versus inpatient TJA across age groups (<75 vs ≥75 years) using 3:1 propensity score matching at a single academic health system from 2021–2023. In patients ≥75, no significant differences were found in readmission, ED visits, PJI, dislocation, or reoperation rates. In patients <75, ASC patients had modestly higher unplanned reoperation (1.6% vs 0.9%, P=0.032) and readmission rates (1.8% vs 0.9%, P=0.008), though absolute differences were small.
Key Limitation
Single academic health system with inherent patient selection bias for ASC placement limits generalizability, as the ≥75 ASC cohort likely represents a highly selected, physiologically optimized subset not representative of the broader elderly arthroplasty population.
Original Abstract
BACKGROUND
Total joint arthroplasty (TJA) has increasingly shifted toward ambulatory surgery centers (ASCs), yet data supporting the safety of this setting for older patients remain limited. This study compared 90-day perioperative outcomes of TJA performed at ASCs versus inpatient hospital settings, stratified by patients younger than 75 and those 75 years or older.
METHODS
We conducted a retrospective cohort study of 10,804 patients undergoing elective primary total hip or knee arthroplasty between 2021 and 2023 at a single academic health system. Patients were stratified by surgical setting (ASC versus hospital) and age group (less than 75 versus ≥ 75 years). Propensity score matching (3:1) was performed using age, sex, race, and Body Mass Index (BMI), yielding 7,150 patients for analysis. The 90-day outcomes included readmissions, emergency department (ED) visits, reoperations, periprosthetic joint infections, dislocations, and periprosthetic fractures.
RESULTS
The ASC patients had significantly shorter lengths of stay, shorter procedure durations, and higher rates of home discharge in both age groups. Among patients ≥ 75 years of age, no significant differences were found in 90-day readmissions (3.6 versus 1.8%, P = 0.15), ED visits (11 versus 12%, P = 0.9), or major complications, including PJI and dislocation. In the under-75 year group, unplanned reoperation (1.6 versus 0.9%, P = 0.032) and readmission rates (1.8 versus 0.9%, P = 0.008) were slightly higher in ASC patients, though absolute rates remained low.
CONCLUSION
The ASC-based TJA demonstrated comparable 90-day outcomes to inpatient surgery in both older and younger adults. Age alone should not preclude patients from ASC consideration for total joint arthroplasty. Site-of-care decisions should be driven by individual physiologic fitness rather than chronological age cutoffs.