Title : Outpatient total elbow arthroplasty – Outcomes and complications: A systematic review and meta-analysis
Abstract:
Background: Total elbow arthroplasty (TEA) is a surgical procedure used in the management of arthritis and fractures. Outpatient total elbow arthroplasty (OTEA) could be a valid option to reduce workforce burden and cost, provided it can be proven to be equally safe and effective as inpatient TEA. This meta-analysis was conducted to evaluate the efficacy and safety of OTEA.
Methods: Literature search was performed in PubMed, Embase, Scopus, and Google Scholar using DistillerSR, with predetermined keywords based on the Patient-Intervention-Control-Outcome (PICO) criteria. Studies characterising OTEA and/or inpatient TEA were included. Total readmissions, revision rates, cost difference, and functional outcome scores were assessed for outpatient versus inpatient TEA. (ROBINS-I) tool was used for bias assessment for observational studies. OpenMeta-Analyst software for analysis.
Results: Four research studies fulfilled inclusion criteria. Incidence of complications was higher in inpatients compared to outpatients (n=121; mean=10.08±9.97 vs n=51; mean=4.25±4.26) with significant difference (t= -1.86; p= 0.037). Total readmissions reported was 84/1166 cases, comprised of 27/421 outpatients and 57/745 inpatients, thus the OTEA procedure is considered a weak protective factor, though not significant, for readmission of the patients (OR=0.496 [0.08-2.69], p=0.39) .The cost of OTEA was lower than inpatient TEA.
Conclusion : Results of outpatient versus inpatient TEA are interesting, complications are noted higher in Inpatient group wheareas, readmissions, functional scores are similar, and the involved cost is less. Level I/II studies in future will help in further standardising the approach of outpatient TEA.
Level of Evidence: Level II.
