By the end of 2050, the incidences of hip and knee arthroplasties performed in the United States are projected to be more than 1.8 million and 4 million, respectively.1 In 2014 alone, more than 1 million elective lower extremity arthroplasties were performed, with collective per procedure expenditures ranging from $16,500 to $75,000. This disbursement covered surgery, hospitalization, and rehabilitative services.2 As the demand for hip and knee arthroplasties continues to escalate, orthopedic surgeons and hospital administrators are striving to provide cost-effective improvements in patient care.3–7 Given the large volume of total joint replacements, even modest reductions in costs will translate into substantial savings in health care expenditures.
With the introduction of the Bundled Payments for Care Improvement initiative by the Centers for Medicare & Medicaid Services, providers receive single payments for each procedure covering all costs related to acute hospital stay, the preoperative period, and the period up to 90 days postoperatively. As per this initiative, payments provided to hospitals are based on their previous year’s benchmark. Going forward, hospitals will receive bonuses for reducing average costs by 2% and penalties for failing to meet average costs. Thus, cost reductions are essential in health care organizations.8
Major expenses associated with lower extremity total joint arthroplasties are affected by implant costs, in-hospital length of stay, perioperative complications, readmissions, and discharge to rehabilitative services.9 In an effort to minimize costs and improve efficiency, orthopedic surgeons have focused on reducing length of stay and inpatient rehabilitation services. This has led to the evolution of outpatient surgery. With advancements such as less invasive surgical procedures, strategies to prevent blood loss, improved perioperative pain control, and rapid rehabilitation protocols, outpatient hip and knee arthroplasties have become a reality.10–12