1. Inpatient Versus Outpatient Outcomes in Total Hip Arthroplasty Patients
Peggy Essick, MS, CCRP; Tamiko MaGee, MS, CCRP: Noah Sheeley, BS
 Introduction
Osteoarthritis, the most common form of joint disease and
affecting millions of people, is regarded as a major cause of
disability, psychological distress, and poor quality of life1.
Joint replacement surgery may be indicated when a person
has severe symptoms and no longer responds to
conservative management. Total hip arthroplasty (THA) is
a commonly performed surgical procedure that helps to
reduce pain and improves both joint function and quality of
life. According to the Centers for Disease and Control and
Prevention, over 330,000 total hip replacements are
performed each year. Healthcare reform has prompted
health care systems to reduce costs, which includes shorter
hospitalization stays. Although, total knee arthroplasty
(TKA) performed on an outpatient basis has become fairly
common, outpatient THA is much less common. Healthcare
providers are beginning to include outpatient THA as a
feasible option for some patients.
Our goal for this poster was to determine if the length of
hospitalization following a THA would have any effect
on self-reported or functional outcomes.
 References
1.Barnsley, Lara, Leslie Barnsley, and Richard Page. "Are Hip
Precautions Necessary Post Total Hip Arthroplasty? A
Systematic Review." Geriatric Orthopaedic Surgery &
Rehabilitation (2015): 2151458515584640.
 Results - Graph 1  Results – Graph 3
 Methods & Materials
We identified over 158 subjects (123 inpatient and 35
outpatient) enrolled in the Zimmer Biomet Vivacit-E THA
post-market trial that seeks to obtain survival and outcome
data. We gathered data for patients that had met the 6 week
interval. Of The EurQol 5D (EQ 5D) and the Harris Hip
Score (HHS) were both used to record patient feedback
regarding quality of life and functionality, as well as length
of stay, BMI, age, gender, and adverse events.
 Hypothesis
Patients who had experienced a less than 24-hour
hospitalization stay would have lower initial self-reported
and functional scores at 6 weeks than patients who had
experienced a typical post THA hospitalization of 2 to 3 days
 Discussion
As evidenced in the results Graphs, outpatient surgery did
not lead to a negative effect regarding self-reported outcomes
or functional scores as of the 6 week interval. The length of
stay versus related AEs analyzed by the Fisher Exact Test,
there was no significance with a p-value of 0.22. The
correlation of the pre-op EQ5D and the pre-op Harris Hip
was 0.626 and the correlation of post op EQ5D and postop
Harris Hip was 0.684.
It would appear that outpatient surgery is a viable option to
consider for the appropriate patient. With healthcare reform
progressing, this option will continue to be studied and
considered by surgeons, patients and hospitals. Due to the
low volume of outpatient THAs, we were unable to obtain
cost data. However, as more outpatient THAs are being done
and the cost data becomes available, its true value will
become evident.
 Conclusion
We rejected our hypothesis that patients who had
experienced a less than 24 hour hospitalization stay would
have lower initial self-reported and functional scores than
patients who had experienced a typical post-THA
hospitalization of 2 to 3 days. We found no relationship
between the length of stay in regards to self-reported and
functional scores among both groups. Future research should
include cost analysis for outcome comparisons; however, at
this time there is not a sufficient number of outpatient THAs
to allow for cost analysis.
 Acknowledgements
We would like to thank Noah Sheeley and Rob Neher for their
contribution with statistical analysis.
 Results – Graph 2
                                       
Two conclusions were made from the analysis of the EQ5D
shown in Graph 1 and 2: (1) Low pre-op scores were
typically inpatient subjects and (2) Post-op scores did not
indicate outpatient THA led to lower scores.
Graph 3 shows 35 hip-related AEs . Of these AEs, only 5
(14%) were attributed to outpatient subjects.
In Graph 4 below, there were a total of 70 unrelated and
related AEs with only 5 (7%) attributed to outpatient
subjects.
 Results – Graph 4