Low Rates of Adverse Events Following Ambulatory Outpatient Total Hip Arthroplasty at a Free-Standing Surgery Center Patrick C. Toy, MD * , Matthew N. Fournier, MD, Thomas W. Throckmorton, MD, William M. Mihalko, MD, PhD Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee article info Article history: Received 1 June 2017 Received in revised form 10 August 2017 Accepted 17 August 2017 Available online xxx Keywords: total hip arthroplasty ambulatory surgery center complications hospital admissions adverse events abstract Background: We proposed to determine the complication and hospital admission rates for patients with total hip arthroplasty (THA) done by a single surgeon in a stand-alone ambulatory surgical center with same-day discharge. Given the recent emphasis on bundled payments for a 90-day episode of care, this same time frame after surgery was chosen to determine patient outcomes. Methods: The records of patients with THAs done through a direct anterior approach by a single surgeon at 2 separate ambulatory surgery centers were reviewed. To analyze the learning curve for outpatient THA, the procedures were arbitrarily divided into 2 groups depending on when they were done: early in our experience or later. Complications were recorded, as were hospital admissions and surgical in- terventions, length of surgery and blood loss, and time spent at the outpatient facility. Results: Over a 3-year period, 145 outpatient THAs were done in 125 patients; 73 were considered to be initial procedures, and 72 were considered to be later procedures. Only one of the 145 procedures (0.7%) required transfer from the outpatient facility to the hospital for a blood transfusion. No other direct admissions to the hospital or transfers to the emergency department from the surgery center were necessary. Surgical interventions were required after 3 (2%) of the 145 arthroplasties in the global period (90 days). Conclusion: This study demonstrated that same-day discharge to home following THA can be safely done without increased complications, readmissions, reoperations, or emergency room visits. © 2017 Elsevier Inc. All rights reserved. Over the last 10 years, primary total joint arthroplasty has steadily transitioned from an inpatient to an outpatient procedure, and a multitude of studies have reported outcomes of “outpatient” total joint arthroplasty [1e8]. The definition of an outpatient experience, however, has been inconsistent. In some studies, an “outpatient” experience involves a shorter stay in a hospital facility (<24 hours) [3,4,6,9], while others describe same-day discharge to a rehabilitation or skilled nursing facility. Most authors, however, use the purest meaning of “outpatient” to indicate that the patient's surgery is conducted in an ambulatory setting and he or she is discharged to home on the same day [5,7,10]. Transitioning from an inpatient to a true outpatient total joint practice requires careful planning and consideration on multiple levels. We proposed to determine the complication and hospital admission rates for patients with total hip arthroplasty (THA) done by a single surgeon in a stand-alone ambulatory surgical center with same-day discharge. Given the recent emphasis on bundled payments for a 90-day episode of care, this same time frame after surgery was chosen to determine patient outcomes. Specifically, attention was directed to length of stay before discharge, compli- cations that potentially limited success of same-day discharge, and hospital admissions during the 90-day postoperative period. Materials and Methods From June 2013 to July 2016, 145 THAs were done in 125 consecutive patients through a direct anterior approach by a single Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2017.08.026. * Reprint requests: Patrick C. Toy, MD, Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104. Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org http://dx.doi.org/10.1016/j.arth.2017.08.026 0883-5403/© 2017 Elsevier Inc. All rights reserved. The Journal of Arthroplasty xxx (2017) 1e5