Outpatient TKA Safe for Medicare Patients

Three dozen Medicare patients who underwent total knee arthroplasty (TKA) at a single surgery center showed no increases in complication rates compared to data from procedures performed at hospitals, according to a study published in the Journal of Orthopedics and Bone Disorders. The results suggest TKA can be safely performed on older individuals at ASCs and supports estimates that case volumes will increase by 143% in the next quarter century as the U.S. population ages.

The study, which involved the monitoring of patients for six months, included 21 men and 15 women with a mean age of 72.4 and an average BMI of 30.9. Fifteen were classified as ASA IIs and 21 were classified as ASA IIIs. Their procedures were performed in the first six months of 2020. The patients’ mean preoperative range of motion in the knee was -6.7 degrees of extension and 114.8 degrees of flexion. Those measurements improved to -3.8 degrees of extension and 104 degrees of flexion two weeks after the procedure and to -2.7 degrees and 114.6 degrees after six weeks. The patients recovered in less 3.5 hours and were in the ASC for just over 6.5 hours

“No patients throughout the study were noted to have any major complications such as a return to the operating room, wound-related infection, thromboembolic events, sepsis or death,” notes the study. “There were zero incidents of intraoperative complications, blood transfusions, admission to the hospital, adverse events within the ASC, VTE or readmissions for postoperative pain.”

The study’s authors aimed to support previous literature that shows TKA is safe for Medicare patients at ASCs. Extensive research already exists that shows the procedure can be successfully performed in outpatient settings and is safe for Medicare patients on an inpatient basis. Total knees were moved from the Centers for Medicare & Medicaid Services’ inpatient-only list in 2018 and added to the agency’s ASC-approved list in 2020.