# Outpatient Total Hip Arthroplasty: A Meta-Analysis
## 4 Discussion  
Results from the present meta-analysis encourage outpatient THA. Indeed, according to the main findings of the present study, the outcome of outpatient THA was similar to the procedure with longer hospitalisation. Indeed, no difference was found in pain, infections, mortality, revision, dislocation, and readmission rates between the two groups. A statistically significant greater risk of DVT in patients following outpatient THA was evidenced. This may result from the reduced care by the health care personnel once discharged [34]. According to this evidence, each centre performing outpatient THA should implement continuous hometcoming welfare activity, to supervise physiotherapy and the monitoring anticoagulant therapy [14]. Comprehensive multidisciplinary cares include the orthopaedic surgeon, nurses, anaesthesiologists, and physical and occupational therapists. To support hometsay recovery, the primary caregiver may help to restore and expedite patient self-care and daily living activities and to reduce mobility [35; 36]. A recent systematic review evidenced a higher rate of within 60 days DVT in outpatient THA patients (outpatient 1.28% versus inpatient 1.21%) [37]. This is the only systematic review which reported a higher rate of DVT in outpatient THA patients. Expanding the literature search to articles which evaluated outpatient total joint arthroplasty, DVT-related risk rate did not significantly differ from outpatient and inpatient TJA groups [5; 16; 38; 39]. Results from the present study indicated that outpatient THA, in appropriately selected populations, may faster restore the patient quality of life without affecting the clinical outcome. Moreover, outpatient THA significantly reduces health-care costs [1; 11; 38; 40]. For a successful outpatient THA, proper patient selection is mandatory [38; 41; 42; 43; 44; 45]. Comorbidities may negatively interfere with the surgical success, being associated with a greater rate of intraoperative and postoperative complications [46]. Suitable patients should be relatively young and healthy, with a solid social support and good performance status [47]. [PERSON] et al. [48] developed the Outpatient Arthroplasty Risk Assessment (OARA) to identify which patients may reliably undergo outpatient arthroplasty. The OARA allows to generate risk categories stratifying patients in nine separate comorbidity layers. On the other extreme, [PERSON] et al. [14] stated that patients with comorbidities can still be safely discharged as outpatient THA, given the pivotal importance of the solid social support and networking after discharge at honestay. Optimal pain management protocols should be adopted to be able to undertake outpatients THA in a safe and effective fashion [38]. Postoperative pain management and appropriate patients care are essential factors for outpatient THA pain control at homes stay, especially during the first postoperative days [22]. Outpatient THA can be successfully achieved thanks to the advancements in pain management, regional anaesthesia, focused rehabilitation, surgical progresses, and the patient selection process [27]. The management of immediate postoperative complications is critical. Anaesthetic-related side effects such as nausea, hypotension, and urinary retention are common and should be promptly managed [22; 26]. The readmission rate is important to evaluate the efficacy of outpatient THA [49; 50]. [PERSON] et al. [13], in 1968, found that the most common causes for THA readmission were bleeding and DVT [13]. [PERSON] et al. [51] evidenced increased readmission rates in outpatient THA (11.7% vs. 6.6%), mostly for pain, wound complications, and adverse reaction to pain medication. [PERSON] et al. [23] found a lower rate of complication and readmission within 30-days postoperatively in favour of outpatient THA. In a recent review, [PERSON] et al. [52] evidenced a within 3 months outpatient THA readmission rate of 0.34%. In this regard, previously published readmission rates for inpatient THA scored higher [17; 53; 54].