The Outpatient Surge in Total Hip Arthroplasty: National Trends in Volume Migration,Demographic Disparities,and Comorbidity Profiles (2019-2022)

Abstract

Background:

Total hip arthroplasty (THA) continues to shift from inpatient to outpatient facilities.

Purpose:

We sought to examine trends in THA settings, demographic differences, and comorbidity variations to inform patient selection, outcomes, and policy.

Methods:

We performed a retrospective study using data from January 1, 2019, to December 31, 2022, which we obtained from the Nationwide Inpatient Sample database and Nationwide Ambulatory Surgery Sample, from the U.S. Agency for Healthcare Research and Quality. Patients undergoing primary, elective THA were identified.

Results:

Of the 1 449 639 patients we identified who underwent elective THA, 843 824 underwent the procedure in a hospital-owned ambulatory facility and 605 815 in a hospital (inpatient setting). A total of 86% of THA volume migrated to outpatient centers from 2019 to 2022. Patients who underwent THA at an outpatient facility versus an inpatient setting were younger (65.3 vs 66.3 years). A higher percentage of female versus male patients had surgery in a hospital than in an outpatient center (56.2% vs 53.8%). White and black patients were more likely to be treated at an inpatient facility, whereas Hispanic patients were more likely to be treated at an outpatient facility. Medicare and Medicaid patients were more likely to undergo surgery as inpatients. Patients with medical comorbidities, as well as smokers and patients with opioid use disorder, were overwhelmingly more likely to undergo inpatient THA.

Conclusion:

This retrospective database analysis found that from 2019 through 2022, outpatient THA numbers increased each year, with 90% of THAs being performed in hospital-owned ambulatory facilities in 2022. Patients with significant medical comorbidities and Medicare/Medicaid insurance, as well as white and black patients, were more likely to have inpatient surgery.

Level of Evidence:

Level III, Retrospective Database Study.

Plain Language Summary

Shifting Hip Replacement Surgery From Hospital Stays to Same-Day Outpatient Care: Trends, Patient Differences, and Health Factors (2019-2022):

Total hip replacement is a common surgery to treat severe hip pain from arthritis. In the past, patients usually stayed in the hospital after surgery. But recently, more people have this surgery as outpatients, often in hospital-owned outpatient centers. This study looked at national data from 2019 to 2022 to see how this change happened and who was getting surgery in different settings. We studied over 1.4 million people who had planned hip replacements. Key findings include: There was a big shift to outpatient surgery. In 2019, only 5% of these surgeries happened in outpatient centers. By 2022, this jumped to 91%. Overall, 86% of the procedures moved from hospitals to outpatient settings during these years. People who had outpatient surgery were usually younger (average age 65.3 years) compared to those in hospitals (average age 66.3 years). More women had surgery in hospitals than in outpatient centers. White and black patients were more likely to have inpatient (hospital) surgery, while Hispanic patients were more likely to have outpatient surgery. Patients with Medicare or Medicaid insurance were more likely to stay in the hospital, while those with private (commercial) insurance were more likely to go home the same day. People with health problems (like heart disease, diabetes, lung issues, or kidney problems), smokers, or those with opioid use issues were much more likely to have surgery in the hospital. These changes happened because of better surgery techniques, improved pain control (like spinal anesthesia), new implants, and policy updates that allowed more procedures outside traditional hospital stays. This helps lower healthcare costs and lets healthy patients recover at home sooner.