Purpose

The purpose of this study was to assess the rate of inpatient conversions, hospital readmissions, reoperations, and complications with tibial tubercle osteotomies (TTO), high tibial osteotomies (HTO), and distal femoral osteotomies (DFO) operations performed at our ambulatory surgery center compared to our inpatient hospital setting.

Methods

A retrospective review of patients receiving a TTO, HTO or DFO at our institution between June 2011 and October 2019 was performed. All patients included had one of the three procedures done at either our inpatient hospital or our ambulatory surgical center (ASC) and had a minimum follow-up of 90 days. Complications, including re-admission and re-operation were compared between the two groups using either the Fisher’s exact test and independent samples t-test, where applicable, and a p-value of < 0.05 was considered to be statistically significant.
RESUTS: The study included 497 patients undergoing osteotomies (180 ASC and 317 hospital) with no patients lost to follow-up in the 90-day post-operative period. No patients operated on at an ASC required transfer to inpatient setting. There were no differences in re-admission or re-operation rates amongst the two groups (3.3% v 4.4%, p 0.6508). Additionally, there were no significant differences in complication rates between those who had surgery in the ASC or hospital for TTOs (3.8% vs 5.1%, p = 0.7885), HTOs (2.7% vs 3.6%, p = 1.0), or DFOs TTOs (0% vs 5.5%, p = 1.0). Complications including surgical site infection and arthrofibrosis were not significantly different in the two cohorts, (1.1% vs. 2.5%, p 0.341 and 0.6% vs 0.9%, p 1.000, respectively).

Conclusions

Osteotomies about the knee performed in an ambulatory setting were safe, with no difference in readmission, reoperation, and post-operative complications compared to those performed at an inpatient hospital. Additionally, no patient required conversion from an outpatient to an inpatient setting.