Overview:
Duke University study compares TKA in an ASC to TKA in a tertiary care university hospital setting.
Researchers from Duke University have just published a study which compares total knee arthroplasty (TKA) in an ambulatory surgery center (ASC) to TKA in a tertiary care university hospital setting. Their work, “Same-Day Discharge Total Knee Arthroplasty: Hospital Demonstrates Similar Outcomes to Ambulatory Surgery Center in a More Complex Patient Population,” appears in the February 2025 edition of The Journal of Arthroplasty.
Speaking to the backstory involved was Michael P. Bolognesi, M.D., Virginia Flower Baker Distinguished Professor and chief of the Division of Adult Reconstruction at Duke University Medical Center. Dr. Bolognesi told OTW, “Our partner, Sean Ryan (senior author), had an interest in looking at the outcomes for same-day discharge from the hospital and at our ASC once we transitioned some of the patient population to the freestanding ASC setting.”
“The assumption has always been that the results are inherently better at the ASC based on patient selection, but we had worked hard to develop a same-day discharge program at our main hospital. This started before COVID, but we really leaned on it during that era.”
Using three years of data (August 2021 to January 2024) from Duke University, researchers looked at 449 patients who had received a primary TKA and were either discharged the same day from an ambulatory surgery center or from a tertiary care university hospital setting.
Study Methodology
The authors note that specific criteria had to be met prior to surgery at the ASC, and the final decision regarding the location of surgery was made via shared decision-making between the patient and surgeon. Patients not meeting the ASC criteria underwent TKA at the main hospital. A total of 63.3% (284) were performed at the ASC and 36.7% were done (165) at the university hospital. Of those 165 whose surgery was done at the hospital, 93.9% met at least one ASC exclusion criteria.
“There is a lot of literature that has shown that same-day discharge from a freestanding center for hip and knee arthroplasty is safe and predictable,” Dr. Bolognesi told OTW. “Our intent is not to disparage any of the great work that has been done to transition these procedures to the outpatient setting.”
“We think that this work supports the option of doing same-day discharge in the hospital setting for the patient population that has enough comorbidities or social needs to lead the surgeon to select that setting for the procedure. We think this just helps doctors justify a decision to go to the ASC or go to the hospital but not give up on the concept at the hospital setting.”
