Bone surgeries, particularly total hip replacement (THA) and total knee arthroplasty (TKA), are common procedures for treating advanced joint conditions like arthritis and avascular necrosis. While these surgeries are highly effective, they are also invasive and resource-intensive, posing challenges for healthcare systems striving to manage costs. However, with the emergence of new surgical techniques and advancements, the average length of hospital stays for these procedures has decreased.
The demand for hip and knee replacements among patients over 65 has been projected to rise significantly due to an increase in Canada’s aging population. In 2019–2020, TKA surgeries alone cost Canada’s healthcare system $700 million CAD, with each inpatient procedure averaging $12,223 CAD.
As these surgeries become more common, healthcare systems are under increasing pressure to find cost-effective solutions to expand access to care. One potential option is same-day discharge arthroplasty, also known as outpatient TKA, where patients have the procedure and go home on the same day. A recent study investigated the cost differences between outpatient and inpatient TKA to assess whether this approach could help alleviate some of the financial strain while maintaining the quality of care.
The study was led by Simon Martel, a fifth-year chief resident in Orthopedic Surgery, and involved researchers from McGill’s Department of Surgery.
The research team examined the costs associated with both outpatient and inpatient TKA by analyzing data from 50 patients—25 treated as outpatients and 25 as inpatients—at a Canadian academic centre. To measure the costs accurately, the team used an activity-based costing (ABC) framework, which breaks down the total resources and expenses involved in patient care.
The findings reveal that inpatient care was more expensive than outpatient care, mainly due to the costs of hospital admissions and associated services like pharmacy use. While outpatient care was slightly more expensive in terms of operating room logistics, it avoided the costs associated with hospital stays, such as room charges and prolonged nursing care. By shifting to outpatient procedures, healthcare systems could reduce the strain on hospital resources, allowing for more patients to receive timely surgeries.
“For fairly healthy patients, there’s no difference in their long-term outcome, whether they stay at the hospital for a few days or whether they’re sent home,” Martel said in an interview with The Tribune.
However, to qualify for outpatient hip and knee replacement surgery, patients must be in good overall health, be motivated to participate in physical therapy after surgery, and have a supportive environment for post-operative recovery and rehabilitation.
The study also found that both outpatient and inpatient groups experienced similar rates of complications and follow-up visits, confirming that outpatient procedures are equally safe when patients are carefully selected. In an era of nursing shortages across North America, reducing post-operative hospital stays for elective joint surgeries could significantly ease the strain on healthcare systems and improve access to orthopedic care.
“The majority of their progress occurs two weeks after the surgery and continues for up to six weeks, so whether they stay in the hospital [overnight] or not, we don’t see much difference in their recovery period,” Martel explained.
If half of Canada’s knee replacement procedures were to transition to the outpatient model, the healthcare system could save over $45 million CAD annually. In addition to the financial savings, outpatient TKA would alleviate hospital burden, improve access to timely surgeries, and address critical workforce challenges, such as nursing shortages.
While these findings are promising, the study has some limitations, such as its single-centre design and small sample size. Larger studies across diverse healthcare settings are needed to confirm the results and evaluate the broader applicability of outpatient TKA.
“If you can save $1,000 [CAD], or 50 per cent of post-operative costs per case, it adds up to a significant amount,” Martel added.
